Provider Demographics
NPI:1669446977
Name:MELDAHL, RAYMOND VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:VICTOR
Last Name:MELDAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 N PARK AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2608
Practice Address - Country:US
Practice Address - Phone:317-431-1437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040597A174400000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00861438OtherRR MEDICARE PTAN
IN100441810AMedicaid
INP000861438OtherRAILROAD
INP01212108OtherRR MEDICARE PTAN
IN677000DMedicare PIN
INP00861438OtherRR MEDICARE PTAN
INP01212108OtherRR MEDICARE PTAN
INE93922Medicare UPIN