=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215987326
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARININEERAJA MEDA M.D.,
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4508 LEGACY DR STE 400
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-2188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-778-2390
-----------------------------------------------------
Fax | 214-778-2394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4508 LEGACY DR STE 400
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-2189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-778-2390
-----------------------------------------------------
Fax | 214-778-2396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | M2710
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------