Provider Demographics
NPI:1346529948
Name:PRADEEP, MEERA (PA-C)
Entity Type:Individual
Prefix:
First Name:MEERA
Middle Name:
Last Name:PRADEEP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 PENNS WAY
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3072
Mailing Address - Country:US
Mailing Address - Phone:908-642-6294
Mailing Address - Fax:908-350-3590
Practice Address - Street 1:465 PENNS WAY
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3072
Practice Address - Country:US
Practice Address - Phone:908-642-6294
Practice Address - Fax:908-350-3590
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00261200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant