1578596649 NPI number — IAN MYERS, MD LLC

Table of content: (NPI 1578596649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578596649 NPI number — IAN MYERS, MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IAN MYERS, MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578596649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 GLASGOW AVE STE 218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-5704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-832-7600
Provider Business Mailing Address Fax Number:
302-832-6700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 GLASGOW AVE STE 218
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19702-5704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-832-7600
Provider Business Practice Location Address Fax Number:
302-832-6700
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
IAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
302-832-7600

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C1-0005890 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00070381 . This is a "MEDICARE RR" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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