Provider Demographics
NPI:1790072452
Name:MEEHL, ELLIE M (PA)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:M
Last Name:MEEHL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:M
Other - Last Name:O'CONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:575 COAL VALLEY RD
Mailing Address - Street 2:SUITE 374
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3730
Mailing Address - Country:US
Mailing Address - Phone:412-469-7746
Mailing Address - Fax:412-469-7745
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:SUITE 374
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3730
Practice Address - Country:US
Practice Address - Phone:412-469-7746
Practice Address - Fax:412-469-7745
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014826363A00000X
PAMA056680363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA341687TOJOtherMEDICARE