Provider Demographics
NPI:1912015942
Name:MECCIA, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MECCIA
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 1:490 S MAPLE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1760
Mailing Address - Country:US
Mailing Address - Phone:952-925-5626
Mailing Address - Fax:
Practice Address - Street 1:490 S MAPLE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1760
Practice Address - Country:US
Practice Address - Phone:952-925-5626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38257207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN391324400Medicaid
MNF23309Medicare UPIN