Provider Demographics
NPI:1518433614
Name:MECK, DAVID ALLAN
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLAN
Last Name:MECK
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:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26763-0406
Mailing Address - Country:US
Mailing Address - Phone:304-538-4424
Mailing Address - Fax:
Practice Address - Street 1:157 MAGNOLIA PLACE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:WV
Practice Address - Zip Code:26763-0406
Practice Address - Country:US
Practice Address - Phone:304-538-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program