Provider Demographics
NPI:1073583191
Name:MEERAN, M. MOHAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:MOHAMED
Last Name:MEERAN
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:100 SCHUYLKILL MEDICAL PLZ STE 206
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3636
Practice Address - Country:US
Practice Address - Phone:570-621-5630
Practice Address - Fax:570-621-5699
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028917E2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010131660002Medicaid
PAC26094Medicare UPIN
PA0010131660002Medicaid