1255301057 NPI number — PATRICK GLEN MELER OTR

Table of content: PATRICK GLEN MELER OTR (NPI 1255301057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255301057 NPI number — PATRICK GLEN MELER OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELER
Provider First Name:
PATRICK
Provider Middle Name:
GLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255301057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CMR 402, BOX 493
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-239-4276
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 482, BOX 2570
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FPO AP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
11-816-1173
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  0119 002808 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)