Provider Demographics
NPI:1043210073
Name:LIDDLE, MEREDITH CAROLINE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:CAROLINE
Last Name:LIDDLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:CAROLINE
Other - Last Name:RIELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9762
Mailing Address - Country:US
Mailing Address - Phone:412-469-7110
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-9762
Practice Address - Country:US
Practice Address - Phone:412-469-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051956363AS0400X
WV2007363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12304260OtherCAQH
087875F4DMedicare ID - Type Unspecified