Provider Demographics
NPI:1255311627
Name:VERMEULEN, MEAGAN W (MD)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:W
Last Name:VERMEULEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:
Other - Last Name:WEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1474 TANYARD ROAD
Mailing Address - Street 2:SUITE D100
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2359
Mailing Address - Country:US
Mailing Address - Phone:856-566-6265
Mailing Address - Fax:856-566-6185
Practice Address - Street 1:1474 TANYARD ROAD
Practice Address - Street 2:SUITE D100
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2359
Practice Address - Country:US
Practice Address - Phone:856-566-6265
Practice Address - Fax:856-566-6185
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07196200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8899703Medicaid
NJH71984Medicare UPIN
NJ433341ASDMedicare PIN