Provider Demographics
NPI:1811215460
Name:MERIDIAN FAMILY MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MERIDIAN FAMILY MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/FNP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BADU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:914-400-4779
Mailing Address - Street 1:3333 BAYSHORE BLVD
Mailing Address - Street 2:250
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1952
Mailing Address - Country:US
Mailing Address - Phone:914-400-4779
Mailing Address - Fax:
Practice Address - Street 1:3333 BAYSHORE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1961
Practice Address - Country:US
Practice Address - Phone:914-400-4779
Practice Address - Fax:713-344-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX735840207R00000X, 207RG0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty