1447248323 NPI number — ARNOLD B MESHKOV MD

Table of content: ARNOLD B MESHKOV MD (NPI 1447248323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447248323 NPI number — ARNOLD B MESHKOV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MESHKOV
Provider First Name:
ARNOLD
Provider Middle Name:
B
Provider Name Prefix Text:
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:
1447248323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1077 RYDAL ROAD
Provider Second Line Business Mailing Address:
SUITE 307
Provider Business Mailing Address City Name:
RYDAL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19046-1712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-920-0815
Provider Business Mailing Address Fax Number:
484-489-2732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1077 RYDAL ROAD
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
RYDAL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19046-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-920-0815
Provider Business Practice Location Address Fax Number:
484-489-2732
Provider Enumeration Date:
10/13/2005

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: 207RI0011X , with the licence number:  MD018369E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0008571050007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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