Provider Demographics
NPI:1265412266
Name:MEO, MARY ANN (DO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:MEO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:2510 E DUPONT RD
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1602
Practice Address - Country:US
Practice Address - Phone:260-969-2990
Practice Address - Fax:260-969-2991
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02002459A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200403130Medicaid
OH2794089Medicaid
OH2794089Medicaid
OH2794089Medicaid
INP00273907Medicare PIN
203267938OtherINDIANA HEALTH NETWORK
P00273907OtherRAILROAD MEDICARE
IN233390AMedicare PIN
13452OtherPHYSICIANS HEALTH PLAN
000000020201OtherMPLAN PARKVIEW
INF94732Medicare UPIN
IN150640UUUMedicare PIN