Provider Demographics
NPI:1356413876
Name:MECKLER, DENISE ANDREA (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANDREA
Last Name:MECKLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 MANCHESTER RD STE 206
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1452
Mailing Address - Country:US
Mailing Address - Phone:314-725-9300
Mailing Address - Fax:314-725-4662
Practice Address - Street 1:9450 MANCHESTER RD STE 206
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1452
Practice Address - Country:US
Practice Address - Phone:314-725-9300
Practice Address - Fax:314-725-4662
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD101246207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SP20077OtherCIGNA
160040600OtherRAILROAD MEDICARE
40324OtherGROUP HEALTH PLAN
4964140OtherAETNA
0700240OtherUNITED HEALTHCARE
109684OtherBCBS
290227OtherHEALTHLINK
0700240OtherUNITED HEALTHCARE
4964140OtherAETNA