Provider Demographics
NPI:1407439714
Name:MEREDITH VANDEGRIFT, MD, PC
Entity Type:Organization
Organization Name:MEREDITH VANDEGRIFT, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDEGRIFT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-935-0303
Mailing Address - Street 1:864 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6064
Mailing Address - Country:US
Mailing Address - Phone:631-935-0303
Mailing Address - Fax:631-935-7616
Practice Address - Street 1:864 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6064
Practice Address - Country:US
Practice Address - Phone:631-935-0303
Practice Address - Fax:631-935-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty