Provider Demographics
NPI:1023089422
Name:MEEHAN, DAVID VENTURA (DO)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:VENTURA
Last Name:MEEHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SHOTWELL RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520
Mailing Address - Country:US
Mailing Address - Phone:919-550-5354
Mailing Address - Fax:919-550-5766
Practice Address - Street 1:45 SHOTWELL RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520
Practice Address - Country:US
Practice Address - Phone:919-550-5354
Practice Address - Fax:919-550-5766
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891206FMedicaid
NC1206FOtherBLUE CROSS BLUE SHIELD
0401760OtherUNITED HEALTHCARE
7210027OtherAETNA
2401125Medicare ID - Type Unspecified
NC891206FMedicaid