MEDICARE: LEFTERIA D MEALY P.A.-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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1578714648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEFTERIA D MEALY P.A.-C

Provider Business Mailing Address
First Line	:	200 POWDER MILL RD
Second Line	:	PO BOX
City	:	WILMINGTON
State	:	DE
Zip	:	19803-2907
Country	:	US
Telephone Number	:	302-695-2437
Fax Number	:	302-695-1364

Provider Business Practice Location Address
First Line	:	200 POWDER MILL RD
Second Line	:	PO BOX
City	:	WILMINGTON
State	:	DE
Zip	:	19803-2907
Country	:	US
Telephone Number	:	302-695-2437
Fax Number	:	302-695-1364

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	04/05/2016

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