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NPI Code Detail

MEDICARE: MEREDITH CAROLINE LIDDLE PA-C

MEDICARE: MEREDITH CAROLINE LIDDLE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantMA051956PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112304260OTHERCAQH

General Provider Information

NPI Number : 1043210073
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEREDITH CAROLINE LIDDLE PA-C
Provider Business Mailing Address
First Line : 100 MEDICAL BLVD
Second Line :
City : CANONSBURG
State : PA
Zip : 15317-9762
Country : US
Telephone Number : 412-469-7110
Fax Number :
Provider Business Practice Location Address
First Line : 100 MEDICAL BLVD
Second Line :
City : CANONSBURG
State : PA
Zip : 15317-9762
Country : US
Telephone Number : 412-469-7110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2005
Last Update Date : 07/11/2022

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Directions to “ MEREDITH CAROLINE LIDDLE PA-C” Practice Location

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