Provider Demographics
NPI:1285800136
Name:JOEL D MESHULAM MD LLC
Entity type:Organization
Organization Name:JOEL D MESHULAM MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MESHULAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-659-7041
Mailing Address - Street 1:301 ST PAUL PLACE
Mailing Address - Street 2:SUITE 804
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2102
Mailing Address - Country:US
Mailing Address - Phone:410-659-7041
Mailing Address - Fax:410-659-7084
Practice Address - Street 1:301 ST PAUL PLACE
Practice Address - Street 2:#804
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-659-7041
Practice Address - Fax:410-659-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD532761000Medicaid
MD532761000Medicaid
MD5141Medicare PIN