Provider Demographics
NPI:1336208693
Name:MEADOWS, TARA M (PAC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 LANDOVER PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2115
Mailing Address - Country:US
Mailing Address - Phone:434-947-3944
Mailing Address - Fax:866-617-8273
Practice Address - Street 1:2215 LANDOVER PL
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2115
Practice Address - Country:US
Practice Address - Phone:434-947-3944
Practice Address - Fax:866-617-8273
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002436363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336208693OtherTRICARE
VA1336208693Medicaid
016132M68OtherMEDICARE
VAP00458958OtherMEDICARE RAILROAD CARRIER