Provider Demographics
NPI:1710983572
Name:MEADE, PATRICK GODFREY (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:GODFREY
Last Name:MEADE
Suffix:
Gender:M
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-431-0090
Mailing Address - Fax:859-431-3168
Practice Address - Street 1:119 FAIRFIELD AVE
Practice Address - Street 2:SUITE R102
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1184
Practice Address - Country:US
Practice Address - Phone:859-431-0090
Practice Address - Fax:859-431-3168
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64049349Medicaid
OH2279449Medicaid
KYP00839907OtherRAILROAD MEDICARE
KY080189333OtherRAILROAD MEDICARE
KY008580082Medicare PIN
KY080189333OtherRAILROAD MEDICARE
KYH41087Medicare UPIN