Basic Information
| Provider Information | |||||||||
| NPI: | 1801113931 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEIZLIK | ||||||||
| FirstName: | PAIGE | ||||||||
| MiddleName: | FORTINSKY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FORTINSKY | ||||||||
| OtherFirstName: | PAIGE | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2450 W HUNTING PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191291302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157074600 | ||||||||
| FaxNumber: | 2157075599 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | FT WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157074600 | ||||||||
| FaxNumber: | 2157075599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2010 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | MD447024 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.