Provider Demographics
NPI:1104951144
Name:MELTZER, AMANDA LILLIAN (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LILLIAN
Last Name:MELTZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MELTZER
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8222 DOUGLAS AVE STE 850
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5936
Mailing Address - Country:US
Mailing Address - Phone:212-369-6757
Mailing Address - Fax:
Practice Address - Street 1:8222 DOUGLAS AVE STE 850
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5936
Practice Address - Country:US
Practice Address - Phone:212-369-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT44322084P0800X, 2084P0800X
CODR.00681332084P0800X
OK398492084P0800X
PAMD4392572084P0800X
HIMD200052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027865240001Medicaid