Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 16926 | SC |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 16926 | SC |
NPI | 1235133158 |
---|---|
Provider Name | Mr. Mark J Meiler |
First Address | King Of Prussia, PA 19406-3121 |
Second Address | Aiken, SC 29803-1731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 08/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B81368 | (02) | SC |