Provider Demographics
NPI:1548656374
Name:VANDERMEID, JUSTIN
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:VANDERMEID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S LLOYD ST STE E201
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4509
Mailing Address - Country:US
Mailing Address - Phone:056-222-5456
Mailing Address - Fax:605-622-2531
Practice Address - Street 1:201 S. STATE ST., STE E201
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5740
Practice Address - Country:US
Practice Address - Phone:056-222-5456
Practice Address - Fax:605-622-2531
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4412084P0800X
SD125982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry