MEDICARE: JOHN R MERANDA & LINDA ELAINE WEBER

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1427078880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN R MERANDA & LINDA ELAINE WEBER

Provider Business Mailing Address
First Line	:	167 W MAIN RD
Second Line	:	SUITE G
City	:	CONNEAUT
State	:	OH
Zip	:	44030-2057
Country	:	US
Telephone Number	:	440-599-8844
Fax Number	:	440-593-6014

Provider Business Practice Location Address
First Line	:	167 W MAIN RD
Second Line	:	SUITE G
City	:	CONNEAUT
State	:	OH
Zip	:	44030-2057
Country	:	US
Telephone Number	:	440-599-8844
Fax Number	:	440-593-6014

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN RICHARD MERANDA
Credential	:	MD
Telephone Number	:	440-599-8844

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	02/27/2012

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