Provider Demographics
NPI:1073983912
Name:MEALING, DOUGLAS ALLEN I
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALLEN
Last Name:MEALING
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FULTON AVE
Mailing Address - Street 2:DOWN
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-1221
Mailing Address - Country:US
Mailing Address - Phone:585-730-5104
Mailing Address - Fax:
Practice Address - Street 1:26 FULTON AVE
Practice Address - Street 2:DOWN
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-1221
Practice Address - Country:US
Practice Address - Phone:585-730-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303297-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse