Provider Demographics
NPI:1336638287
Name:MCNELIS, MEREDITH ANN (MS)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANN
Last Name:MCNELIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:261 OLD YORK RD STE 724
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3725
Mailing Address - Country:US
Mailing Address - Phone:215-671-4280
Mailing Address - Fax:
Practice Address - Street 1:9501 ROOSEVELT BLVD, ST 501
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1911
Practice Address - Country:US
Practice Address - Phone:215-673-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA060436363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical