Provider Demographics
NPI:1558881300
Name:MEREDITH, CHARISSA D (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARISSA
Middle Name:D
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 PROVIDENCE DR STE 425
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4603
Mailing Address - Country:US
Mailing Address - Phone:907-561-7111
Mailing Address - Fax:
Practice Address - Street 1:3260 PROVIDENCE DR STE 425
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4629
Practice Address - Country:US
Practice Address - Phone:907-561-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101023081207V00000X
AK190400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology