Provider Demographics
NPI:1437124302
Name:JOSEPH, MEENA A (MD)
Entity Type:Individual
Prefix:MRS
First Name:MEENA
Middle Name:A
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MEENA
Other - Middle Name:A
Other - Last Name:ZACHARIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 MARKHAM WOODS RD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2776
Mailing Address - Country:US
Mailing Address - Phone:407-774-5373
Mailing Address - Fax:
Practice Address - Street 1:400 W AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5496
Practice Address - Country:US
Practice Address - Phone:407-665-3330
Practice Address - Fax:407-665-3213
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59989208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE97190Medicare UPIN