Provider Demographics
NPI:1235133158
Name:MEILER, MARK J (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:J
Last Name:MEILER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:367 S. GULPH RD
Mailing Address - Street 2:ATT: IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:803-648-7774
Mailing Address - Fax:
Practice Address - Street 1:420 SOCIETY HILL DR STE 100
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-1731
Practice Address - Country:US
Practice Address - Phone:803-648-7774
Practice Address - Fax:803-648-7490
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC16926207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB81368Medicare UPIN
P00375191Medicare PIN
SCB813684856Medicare PIN
SC5349Medicare PIN