1114951076 NPI number — DR. JOHN FREDERICK MEYERS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114951076 NPI number — DR. JOHN FREDERICK MEYERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYERS
Provider First Name:
JOHN
Provider Middle Name:
FREDERICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETTY
Provider Other First Name:
DIANE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1114951076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 DOYLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLDEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01520-2016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-856-0888
Provider Business Mailing Address Fax Number:
508-856-7425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
189 MAY ST.
Provider Second Line Business Practice Location Address:
FAIRLAWN REHAB HOSP
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-791-6351
Provider Business Practice Location Address Fax Number:
508-754-2087
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  53933 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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