Provider Demographics
NPI:1891725396
Name:MEADOR, ROBERT J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:MEADOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1301 TRUMANSBURG RD
Mailing Address - Street 2:SUITE R
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1397
Mailing Address - Country:US
Mailing Address - Phone:607-277-2710
Mailing Address - Fax:607-257-2923
Practice Address - Street 1:1301 TRUMANSBURG ROAD
Practice Address - Street 2:SUITE R
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5738
Practice Address - Country:US
Practice Address - Phone:607-277-2710
Practice Address - Fax:607-257-2923
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK5626207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN660003815OtherRR MEDICARE
TX152193201Medicaid
NY204356115Medicaid
TX8790B7Medicare ID - Type Unspecified
NY204356115Medicaid