Provider Demographics
NPI:1932424967
Name:MEEHAN, COLETTE SAINT MARYLIN (MD)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:SAINT MARYLIN
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:301 E WENDOVER AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1210
Mailing Address - Country:US
Mailing Address - Phone:336-272-6161
Mailing Address - Fax:336-230-2150
Practice Address - Street 1:301 E WENDOVER AVE STE 311
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1210
Practice Address - Country:US
Practice Address - Phone:336-272-6161
Practice Address - Fax:336-230-2150
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1175812080P0205X
NC2021-028772080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017213400Medicaid