Provider Demographics
NPI:1811916760
Name:SIDDHARTH, MEERA B (MD)
Entity type:Individual
Prefix:
First Name:MEERA
Middle Name:B
Last Name:SIDDHARTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39TH & CHESTNUT STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4399
Mailing Address - Country:US
Mailing Address - Phone:215-590-5090
Mailing Address - Fax:215-590-5048
Practice Address - Street 1:39TH & CHESTNUT STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4399
Practice Address - Country:US
Practice Address - Phone:215-590-5090
Practice Address - Fax:215-590-5048
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417714208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001943137Medicaid
NJ0001791Medicaid
NJ0001791Medicaid
H79288Medicare UPIN