Provider Demographics
NPI:1104289297
Name:MERIDIAN MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:MERIDIAN MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT-CERTIFIED
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:ANTOINE
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:240-766-4552
Mailing Address - Street 1:5620 SAINT BARNABAS RD STE 360
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3628
Mailing Address - Country:US
Mailing Address - Phone:240-766-4552
Mailing Address - Fax:240-766-4502
Practice Address - Street 1:5620 SAINT BARNABAS RD STE 360
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745
Practice Address - Country:US
Practice Address - Phone:240-766-4552
Practice Address - Fax:240-766-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD577202800Medicaid