Provider Demographics
NPI:1770999336
Name:BADAWI, MEREDITH ASHLEY (PA-C)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ASHLEY
Last Name:BADAWI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:ASHLEY
Other - Last Name:STACKHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:552 S OLD MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063
Mailing Address - Country:US
Mailing Address - Phone:609-744-4389
Mailing Address - Fax:
Practice Address - Street 1:3737 MARKET ST
Practice Address - Street 2:FLOOR 7
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-3340
Practice Address - Fax:215-222-8858
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058805363AS0400X
VA0110004650363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1407815756Medicare PIN