Provider Demographics
NPI:1427090745
Name:MEREDITH, MELISSA D (CNM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MIDDLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3636
Mailing Address - Country:US
Mailing Address - Phone:302-629-6611
Mailing Address - Fax:
Practice Address - Street 1:4745 OGLETOWN STANTON RD STE 106
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-1339
Practice Address - Country:US
Practice Address - Phone:302-454-9800
Practice Address - Fax:302-454-6446
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELK0000136367A00000X
MDAC000100367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1427090745Medicaid
MDLT35 / 606879-02OtherBC / BS OF MD
MDS186 / 0072OtherBLUECHOICE
MDLT35 / 606879-02OtherBC / BS OF MD