Provider Demographics
NPI:1649225764
Name:MEADEMA, SAMUEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:MEADEMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:159 EXECUTIVE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4160
Mailing Address - Country:US
Mailing Address - Phone:434-792-0830
Mailing Address - Fax:434-792-0468
Practice Address - Street 1:159 EXECUTIVE DR
Practice Address - Street 2:SUITE C
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4160
Practice Address - Country:US
Practice Address - Phone:434-792-0830
Practice Address - Fax:434-792-0468
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-10-10
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Provider Licenses
StateLicense IDTaxonomies
VA0101031594207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA040000105OtherTRAILBLAZER HEALTH ENTERPRISES, LLC
VA032223OtherBCBS OF VA
VA032223OtherBCBS OF VA