Provider Demographics
NPI:1922335165
Name:JOEL D MESHULAM, MD, PA
Entity Type:Organization
Organization Name:JOEL D MESHULAM, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MESHULAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-659-7041
Mailing Address - Street 1:301 SAINT PAUL PL
Mailing Address - Street 2:SUITE 804
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2102
Mailing Address - Country:US
Mailing Address - Phone:410-659-7041
Mailing Address - Fax:410-659-7084
Practice Address - Street 1:301 SAINT PAUL PL
Practice Address - Street 2:SUITE 804
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-659-7041
Practice Address - Fax:410-659-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38675261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE25312Medicare UPIN
MD5141Medicare PIN