Provider Demographics
NPI:1447293204
Name:MESZAROS, AMANDA (DPM)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MESZAROS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44096-1086
Mailing Address - Country:US
Mailing Address - Phone:216-645-7242
Mailing Address - Fax:440-975-8278
Practice Address - Street 1:60 S PLEASANT ST
Practice Address - Street 2:SUITE A
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1633
Practice Address - Country:US
Practice Address - Phone:440-774-1100
Practice Address - Fax:440-774-4306
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003399213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2672406Medicaid
OHME4187263Medicare PIN