Provider Demographics
NPI:1427202837
Name:MECK, JEREMY W (PAC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:W
Last Name:MECK
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1174
Mailing Address - Country:US
Mailing Address - Phone:610-882-0284
Mailing Address - Fax:610-882-0218
Practice Address - Street 1:826 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1174
Practice Address - Country:US
Practice Address - Phone:610-882-0284
Practice Address - Fax:610-882-0218
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053662363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical