NPIMap

Individual provider Active NPI

Meredith Ann Luckenbaugh, M.D.

  • Pediatrics Physician
  • Rehoboth Beach, DE
National Provider Identifier
1649569187
Registry record updated Jan 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
C1-0010951 Issued in DE
Practice address
18947 John J Williams Hwy
Suite 212
Rehoboth Beach, DE 19971-4474
Phone
(302) 645-8212
Fax
(302) 645-5041
NPI assigned
Apr 5, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X C1-0010951 DE Primary

Addresses

Primary practice location

18947 John J Williams Hwy
Suite 212
Rehoboth Beach, DE 19971-4474

Mailing address

18947 John J Williams Hwy
Suite 212
Rehoboth Beach, DE 19971-4474
Phone (302) 645-8212

Other practice location 1

32566 Docs Pl Unit 1
Millville, DE 19967-6959
Phone (302) 645-8212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C1-0010951DEMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Pediatrics LLC Pediatrics Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mluckenbaugh22790@beebehealth.direct-ci.com
  • Direct secure messaging: meredith.luckenbaugh.1@14827.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/14827/brand/1/csg/1/fhir/r4

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1649569187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18947 JOHN J WILLIAMS HWY",
            "address_2": "SUITE 212",
            "city": "REHOBOTH BEACH",
            "state": "DE",
            "postal_code": "199714474",
            "telephone_number": "302-645-8212",
            "fax_number": "302-645-5041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18947 JOHN J WILLIAMS HWY",
            "address_2": "SUITE 212",
            "city": "REHOBOTH BEACH",
            "state": "DE",
            "postal_code": "199714474",
            "telephone_number": "302-645-8212",
            "fax_number": "302-645-5041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "32566 Docs Pl Unit 1",
            "address_purpose": "LOCATION",
            "city": "Millville",
            "state": "DE",
            "postal_code": "199676959",
            "country_code": "US",
            "telephone_number": "302-645-8212",
            "fax_number": "302-645-2199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUCKENBAUGH",
        "first_name": "MEREDITH",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-05",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "DE",
            "license": "C1-0010951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rehoboth Beach, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.