Provider Demographics
NPI:1871731877
Name:TORDELLA, MEAGHAN LINDSAY (PA-C)
Entity type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:LINDSAY
Last Name:TORDELLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:LINDSAY
Other - Last Name:MACKINNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2800 BLUE RIDGE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6477
Mailing Address - Country:US
Mailing Address - Phone:919-784-3324
Mailing Address - Fax:
Practice Address - Street 1:2800 BLUE RIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6477
Practice Address - Country:US
Practice Address - Phone:919-784-3324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant