Provider Demographics
NPI:1508830647
Name:MCNALLY, MEREDYTHE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MEREDYTHE
Middle Name:A
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 SOUTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-3464
Mailing Address - Country:US
Mailing Address - Phone:330-337-8709
Mailing Address - Fax:330-337-9019
Practice Address - Street 1:2020 E STATE ST
Practice Address - Street 2:SUITE H
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2480
Practice Address - Country:US
Practice Address - Phone:330-337-8709
Practice Address - Fax:330-337-9019
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45058207RG0100X
OH35090015207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN155105100Medicaid
OH2754550Medicaid
H156630Medicare PIN
OH2754550Medicaid
MN100000615Medicare ID - Type Unspecified
OH2896951Medicaid