Provider Demographics
NPI:1457408791
Name:MERIDIAN PAIN AND DIAGNOSTICS
Entity Type:Organization
Organization Name:MERIDIAN PAIN AND DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:FREEMAN
Authorized Official - Last Name:DE MEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-448-6166
Mailing Address - Street 1:401 S.W. 42 AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1938
Mailing Address - Country:US
Mailing Address - Phone:305-448-6166
Mailing Address - Fax:305-448-6150
Practice Address - Street 1:401 S.W. 42 AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1938
Practice Address - Country:US
Practice Address - Phone:305-448-6166
Practice Address - Fax:305-448-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55849208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty