Provider Demographics
NPI:1013119254
Name:PHILIP D MEADOR JR MD PA
Entity Type:Organization
Organization Name:PHILIP D MEADOR JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MEADOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-492-2123
Mailing Address - Street 1:568 RUIN CREEK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2880
Mailing Address - Country:US
Mailing Address - Phone:252-492-2123
Mailing Address - Fax:252-436-0031
Practice Address - Street 1:568 RUIN CREEK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2880
Practice Address - Country:US
Practice Address - Phone:252-492-2123
Practice Address - Fax:252-436-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17395174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8958290Medicaid
NC58290OtherBCBSNC
NC201848Medicare ID - Type Unspecified
NCC80968Medicare UPIN