Provider Demographics
NPI:1740292663
Name:MEAGHER, DAVID P JR (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:MEAGHER
Suffix:JR
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 1:554 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1642
Mailing Address - Country:US
Mailing Address - Phone:937-885-1581
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDREN'S PLAZA
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1815
Practice Address - Country:US
Practice Address - Phone:937-461-5020
Practice Address - Fax:937-641-3107
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0913482086S0120X, 208600000X
CAC50457208600000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD82288Medicare UPIN
CA00C504570Medicare ID - Type Unspecified