Healthcare Provider Details

I. General information

NPI: 1023674728
Provider Name (Legal Business Name): LANNY MEADOWS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 01/09/2025
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RALEIGH AVE
BECKLEY WV
25801-0002
US

IV. Provider business mailing address

252 RURAL ACRES DR
BECKLEY WV
25801-3503
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-8541
  • Fax: 304-253-2507
Mailing address:
  • Phone: 304-253-2628
  • Fax: 304-252-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30093
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: