Individual
SHANNON MARIE MEREDITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
195 FORE RIVER PKWY, SUITE 210, PORTLAND, ME 04102-2780
(207) 553-6682
(207) 553-6681
Mailing address
144 STATE ST, PORTLAND, ME 04101-3776
(207) 879-3000
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1000
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001299
MARTINS POINT
ME
01
—
014284
ANTHEM BLUE CROSS
ME
01
—
100429800
DEPT OF LABOR
—
01
—
104104
AETNA
ME
05
—
127440000
—
ME
01
—
14284
FEDERAL BLUE SHIELD
—
01
—
480016606
RAILROAD MEDICARE
ME
01
—
U47765
HARVARD PILGRIM
ME
Enumeration date
06/09/2006
Last updated
08/18/2008
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