Provider Demographics
NPI:1073740957
Name:PROVOST, MEREDITH PRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:PRICE
Last Name:PROVOST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10610 N. PENNSYLVANIA ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2000
Mailing Address - Country:US
Mailing Address - Phone:317-575-6565
Mailing Address - Fax:317-581-9207
Practice Address - Street 1:10610 N PENNSYLVANIA ST STE 101
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2000
Practice Address - Country:US
Practice Address - Phone:317-575-6565
Practice Address - Fax:317-581-9207
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR71523207V00000X
IN01076991A207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology