Provider Demographics
NPI:1235338955
Name:MCINERNEY, MEGHAN A (MD)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:A
Last Name:MCINERNEY
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 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-2000
Mailing Address - Fax:208-302-2055
Practice Address - Street 1:1075 N CURTIS ROAD
Practice Address - Street 2:STE 200
Practice Address - City:BOISE
Practice Address - State:IN
Practice Address - Zip Code:83706-1350
Practice Address - Country:US
Practice Address - Phone:208-302-2000
Practice Address - Fax:208-302-2055
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME018530207R00000X, 208M00000X
IN11016461A207RP1001X
IDM-13166207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001760601Medicare PIN
NH30209779Medicaid