Provider Demographics
NPI:1790849842
Name:MEREDITH, JOHN TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TODD
Last Name:MEREDITH
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 1:3583 HUNTERS GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1925
Mailing Address - Country:US
Mailing Address - Phone:859-971-2499
Mailing Address - Fax:
Practice Address - Street 1:2040 CONCOURSE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4119
Practice Address - Country:US
Practice Address - Phone:314-872-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30991207ZP0102X
TNMD 013910207ZP0102X
GA302249207ZP0102X
WV18038207ZP0102X
FLME 45118207ZP0102X
IN01056379A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E07803Medicare UPIN