Provider Demographics
NPI:1659944031
Name:MEREDITH, SUSAN C (BC-HIS, ACA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:BC-HIS, ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 STAFFORD DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2405
Mailing Address - Country:US
Mailing Address - Phone:304-487-0821
Mailing Address - Fax:304-425-2265
Practice Address - Street 1:900 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2405
Practice Address - Country:US
Practice Address - Phone:304-487-0821
Practice Address - Fax:304-425-2265
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV834174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist