Provider Demographics
NPI:1437902186
Name:OLIVET, MEAGAN MANDABACH (MD)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:MANDABACH
Last Name:OLIVET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:KERRY
Other - Last Name:MANDABACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 22ND ST S FL 3
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-3110
Mailing Address - Country:US
Mailing Address - Phone:205-934-5188
Mailing Address - Fax:
Practice Address - Street 1:500 22ND ST S FL 3
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3110
Practice Address - Country:US
Practice Address - Phone:205-934-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program