Provider Demographics
NPI:1417118597
Name:VANDEGRIFT, MEREDITH T (MD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:T
Last Name:VANDEGRIFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69728208200000X
NY252484208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery