Provider Demographics
NPI:1164952099
Name:MEIER, GRACE LOUDON (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:LOUDON
Last Name:MEIER
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:P.O. BOX 500
Mailing Address - Street 2:
Mailing Address - City:INTERCOURSE
Mailing Address - State:PA
Mailing Address - Zip Code:17534-9998
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 COMMUNITY LANE
Practice Address - Street 2:
Practice Address - City:GORDONVILLE
Practice Address - State:PA
Practice Address - Zip Code:17529
Practice Address - Country:US
Practice Address - Phone:717-687-9407
Practice Address - Fax:717-687-9237
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT213659390200000X
PAMD470035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program