Provider Demographics
NPI:1437111341
Name:MEEHAN, JOAN N (DO)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:N
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GUY RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-7206
Mailing Address - Country:US
Mailing Address - Phone:919-553-3900
Mailing Address - Fax:919-553-0395
Practice Address - Street 1:100 GUY RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-7206
Practice Address - Country:US
Practice Address - Phone:919-553-3900
Practice Address - Fax:919-553-0395
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC317377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8958483Medicaid
NCD33066Medicare UPIN
NC8958483Medicaid