Provider Demographics
NPI:1346323821
Name:MCMEEL, JOHN WALLACE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALLACE
Last Name:MCMEEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 AUTUMN ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5301
Mailing Address - Country:US
Mailing Address - Phone:617-632-7777
Mailing Address - Fax:617-632-7770
Practice Address - Street 1:1 AUTUMN ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5301
Practice Address - Country:US
Practice Address - Phone:617-632-7777
Practice Address - Fax:617-632-7770
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-10-26
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Provider Licenses
StateLicense IDTaxonomies
MA26623207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2085445Medicaid
MA706773OtherTUFTS HEALTH PLAN
MAM13120OtherBCBS MA
MA706773OtherTUFTS HEALTH PLAN
MAM04030Medicare ID - Type Unspecified
MAM04030Medicare PIN