Basic Information
| Provider Information | |||||||||
| NPI: | 1568530178 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEKO | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | BUPP | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 PHEASANT HILL RD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041079661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152607921 | ||||||||
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| Practice Location | |||||||||
| Address1: | 895 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041032737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077913888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 213661 | NY | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 207P00000X | 12405 | NV | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD0000035391 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208G00000X | 35391 | TN | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 207P00000X | 213661 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4054654 | 05 | TN | MEDICAID | 4215248 | 01 | TN | BCBS-TN | OTHER | 1510701 | 05 | TN | MEDICAID |