Provider Demographics
NPI:1285808725
Name:MEADOWS, TELLY ALI (MD)
Entity type:Individual
Prefix:DR
First Name:TELLY
Middle Name:ALI
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-633-9620
Mailing Address - Fax:704-633-7504
Practice Address - Street 1:401 MOCKSVILLE AVE FL 2
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2735
Practice Address - Country:US
Practice Address - Phone:704-633-9620
Practice Address - Fax:704-633-7504
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2010-00033207RC0000X, 207RI0011X
OH57.009785207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC3876CMedicare UPIN