Provider Demographics
NPI:1538144472
Name:DIERKS, MEGHAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:M
Last Name:DIERKS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 GENERAL ST
Mailing Address - Street 2:ANDREA SULLIVAN-DIRECTOR OF MANAGED CARE DEPT.
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2961
Mailing Address - Country:US
Mailing Address - Phone:978-683-4000
Mailing Address - Fax:978-946-8017
Practice Address - Street 1:1 GENERAL ST
Practice Address - Street 2:ANDREA SULLIVAN-DIRECTOR OF MANAGED CARE DEPT.
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2961
Practice Address - Country:US
Practice Address - Phone:978-683-4000
Practice Address - Fax:978-946-8017
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA155821207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF39613Medicare UPIN