Provider Demographics
NPI:1881979870
Name:MEADE, TAMMI L (PA)
Entity type:Individual
Prefix:
First Name:TAMMI
Middle Name:L
Last Name:MEADE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TAMMI
Other - Middle Name:L
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 S 5TH AVE
Practice Address - Street 2:BLDG N GROUND
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-2143
Practice Address - Country:US
Practice Address - Phone:484-628-0900
Practice Address - Fax:484-628-0901
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055282363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA230271OtherMEDICARE PTAN