1356355226 NPI number — MR. PATRICK J MEEHAN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356355226 NPI number — MR. PATRICK J MEEHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEEHAN
Provider First Name:
PATRICK
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1356355226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 223323
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANTILLY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20153-3323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-349-0595
Provider Business Mailing Address Fax Number:
540-349-0587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20186-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-349-0595
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2006

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: 207PE0004X , with the licence number:  0101237704 , 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)

  • Identifier: 010160146 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010160154 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".