Provider Demographics
NPI:1033429378
Name:ZULOAGA, MEREDITH C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:C
Last Name:ZULOAGA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MEREDITH
Other - Middle Name:C
Other - Last Name:LERCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:CREDENTIALS DEPT
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-0209
Practice Address - Country:US
Practice Address - Phone:570-271-5185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant