=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881694172
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILHELM MERIWETHER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2005
-----------------------------------------------------
Last Update Date | 10/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 363 SUNRISE BLVD
-----------------------------------------------------
City | ROMNEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26757-4607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-822-4561
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9213 PEGASUS CT
-----------------------------------------------------
City | POTOMAC
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20854-1661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-994-5252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | D08635
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------