Provider Demographics
NPI:1568530178
Name:MEKO, JENNIFER BUPP (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BUPP
Last Name:MEKO
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 1:9 PHEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04107-9661
Mailing Address - Country:US
Mailing Address - Phone:615-260-7921
Mailing Address - Fax:
Practice Address - Street 1:895 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2737
Practice Address - Country:US
Practice Address - Phone:207-791-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000035391207P00000X
NY213661207P00000X, 208G00000X
MEMD24057207P00000X
TN35391208G00000X
NV12405207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510701Medicaid
TN4215248OtherBCBS-TN
TN4054654Medicaid
TN3864733Medicare ID - Type Unspecified
TN1510701Medicaid
TN38647312Medicare PIN