Provider Demographics
NPI:1386618163
Name:MEIDT, CHARLES E (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:MEIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FOUR FALLS CORPORATE CENTER
Mailing Address - Street 2:SUITE 260
Mailing Address - City:WEST CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-3231
Mailing Address - Country:US
Mailing Address - Phone:844-826-3446
Mailing Address - Fax:610-527-0334
Practice Address - Street 1:300 FOUR FALLS CORPORATE CENTER
Practice Address - Street 2:SUITE 260
Practice Address - City:WEST CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1942
Practice Address - Country:US
Practice Address - Phone:844-826-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044255L207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherMAIN LINE HEALTHCARE
PA100831415Medicaid
C53022Medicare UPIN
PA232359401OtherMAIN LINE HEALTHCARE