Provider Demographics
NPI:1487729422
Name:MEZA, EDUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:MEZA
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 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:835 SPRINGDALE DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2841
Practice Address - Country:US
Practice Address - Phone:610-363-1488
Practice Address - Fax:484-713-1030
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI665382084P0800X, 2084P0804X
VA01012667572084P0800X, 2084P0804X
SD50922084P0804X
PATMD0048262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7101790Medicaid
SD4995887OtherBCBS
SD241532OtherMIDLANDS CHOICE
ND12788Medicaid
SD340071040211OtherPREFERRED ONE
SD5092OtherDAKOTACARE
SDHP40329OtherHEALTH PARTNERS
SDHP40329OtherHEALTH PARTNERS
SD340071040211OtherPREFERRED ONE
SDP00274020Medicare PIN