1295725497 NPI number — MR. MATTHEW A MEYER MD

Table of content: MR. MATTHEW A MEYER MD (NPI 1295725497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295725497 NPI number — MR. MATTHEW A MEYER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYER
Provider First Name:
MATTHEW
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
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:
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:
1295725497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2932 NATHANIELS RUN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23185-7501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-389-9050
Provider Business Mailing Address Fax Number:
262-549-1657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2932 NATHANIELS RUN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23185-7501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-549-2229
Provider Business Practice Location Address Fax Number:
262-549-1657
Provider Enumeration Date:
10/27/2005

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: 207V00000X , with the licence number:  19568-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 387671751007 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 31215400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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