Provider Demographics
NPI:1902884745
Name:RICHARD T MEREDICK DPM PC
Entity Type:Organization
Organization Name:RICHARD T MEREDICK DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:MEREDICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-342-4009
Mailing Address - Street 1:201 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-3303
Mailing Address - Country:US
Mailing Address - Phone:570-342-4009
Mailing Address - Fax:570-342-4326
Practice Address - Street 1:201 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-3303
Practice Address - Country:US
Practice Address - Phone:570-342-4009
Practice Address - Fax:570-342-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001634L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072412OtherFIRST PRIORITY
PA480033867OtherPALMETTO GBA
PA10508OtherGEISINGER
PA4083187OtherAETNA
PA0005056950001Medicaid
PA160567Medicare ID - Type Unspecified
PA4083187OtherAETNA
T29789Medicare UPIN
PA608795Medicare ID - Type UnspecifiedGROUP #