MEDICARE: THE MERIDIAN GROUP OF CHESTERFIELD

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	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	252743000	OTHER		MAGELLAN

General Provider Information

NPI Number	:	1467476093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MERIDIAN GROUP OF CHESTERFIELD

Provider Business Mailing Address
First Line	:	9401 COURTHOUSE RD STE 200
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6687
Country	:	US
Telephone Number	:	804-751-8644
Fax Number	:	804-751-0648

Provider Business Practice Location Address
First Line	:	9401 COURTHOUSE RD STE 200
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6687
Country	:	US
Telephone Number	:	804-751-8644
Fax Number	:	804-751-0648

Authorized Official
Title or Position	:	PH.D.
Name	:	JOHN PATRICK DWYER
Credential	:
Telephone Number	:	804-751-8644

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	12/30/2025

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Directions to “THE MERIDIAN GROUP OF CHESTERFIELD ” Practice Location

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