Provider Demographics
NPI:1407522451
Name:FUNWI, MEATERAN A
Entity Type:Individual
Prefix:MR
First Name:MEATERAN
Middle Name:A
Last Name:FUNWI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17498 IRISHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:EMMITSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21727-9275
Mailing Address - Country:US
Mailing Address - Phone:301-401-0196
Mailing Address - Fax:
Practice Address - Street 1:13121 BROOK LN
Practice Address - Street 2:13121 BROOK LN
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742
Practice Address - Country:US
Practice Address - Phone:301-733-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR238827.363LP0808X
DCNP500007332363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1407522451Medicaid