Provider Demographics
NPI:1609862721
Name:MERIWETHER, COLLEEN J (DO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:J
Last Name:MERIWETHER
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 1:1263 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986
Mailing Address - Country:US
Mailing Address - Phone:304-536-3665
Mailing Address - Fax:
Practice Address - Street 1:1263 MAIN ST E
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986-5031
Practice Address - Country:US
Practice Address - Phone:304-536-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1488207Q00000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055146000Medicaid
WV0789993Medicare PIN