Provider Demographics
NPI:1265277339
Name:MEDDLETON, ELIJAH WILLIAM
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:WILLIAM
Last Name:MEDDLETON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PRINCETON DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2869
Mailing Address - Country:US
Mailing Address - Phone:505-933-4410
Mailing Address - Fax:
Practice Address - Street 1:211 PRINCETON DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2869
Practice Address - Country:US
Practice Address - Phone:505-933-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker