Provider Demographics
NPI:1649569187
Name:LUCKENBAUGH, MEREDITH ANN (MD)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:ANN
Last Name:LUCKENBAUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18947 JOHN J WILLIAMS HWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4474
Mailing Address - Country:US
Mailing Address - Phone:302-645-8212
Mailing Address - Fax:302-645-5041
Practice Address - Street 1:18947 JOHN J WILLIAMS HWY
Practice Address - Street 2:SUITE 212
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4474
Practice Address - Country:US
Practice Address - Phone:302-645-8212
Practice Address - Fax:302-645-5041
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0010951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics