Provider Demographics
NPI:1508288168
Name:MENG, HAO
Entity Type:Individual
Prefix:
First Name:HAO
Middle Name:
Last Name:MENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SHORELAKE DR APT K
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1469
Mailing Address - Country:US
Mailing Address - Phone:305-343-8938
Mailing Address - Fax:
Practice Address - Street 1:3200 NORTHLINE AVE STE 250
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7619
Practice Address - Country:US
Practice Address - Phone:336-938-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04713363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1508288168Medicaid
SC1835PAMedicaid
NCNCH195AMedicare PIN