Provider Demographics
NPI:1427036888
Name:MENON, MEERA C (MD)
Entity type:Individual
Prefix:DR
First Name:MEERA
Middle Name:C
Last Name:MENON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHERUVATTATH
Other - Middle Name:M
Other - Last Name:MENON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15640 N 28TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4059
Mailing Address - Country:US
Mailing Address - Phone:602-439-9000
Mailing Address - Fax:602-978-5233
Practice Address - Street 1:15640 N 28TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4059
Practice Address - Country:US
Practice Address - Phone:602-439-9000
Practice Address - Fax:602-978-5233
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35126174400000X
NC2002-00956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891320GMedicaid
P00421896OtherRAILROAD
NCI02751Medicare UPIN
NC891320GMedicaid
AZZ120735Medicare PIN