Provider Demographics
NPI:1205160801
Name:RAPPAPORT, MEREDITH (PA-C, LCSW)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:RAPPAPORT
Suffix:
Gender:F
Credentials:PA-C, LCSW
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:RAPPAPORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:KINGFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04947-0114
Mailing Address - Country:US
Mailing Address - Phone:865-297-2497
Mailing Address - Fax:
Practice Address - Street 1:5501 FORTUNES RIDGE DR STE P
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6102
Practice Address - Country:US
Practice Address - Phone:919-319-7202
Practice Address - Fax:919-391-7203
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW50101041C0700X
NC0010-12177363A00000X, 363AM0700X
TN5287363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical