Provider Demographics
NPI:1790148518
Name:MORSE, MEREDITH O (MD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:O
Last Name:MORSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12780 ROACHTON RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1350
Mailing Address - Country:US
Mailing Address - Phone:419-872-0777
Mailing Address - Fax:419-931-0912
Practice Address - Street 1:12780 ROACHTON RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1350
Practice Address - Country:US
Practice Address - Phone:419-872-0777
Practice Address - Fax:419-931-0912
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35138871207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35138871OtherSTATE LICENSE