Provider Demographics
NPI:1023011673
Name:MYERS, TODD RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:RICHARD
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:410 2ND ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2115
Practice Address - Country:US
Practice Address - Phone:740-374-3622
Practice Address - Fax:740-374-4209
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075798M207V00000X
WV19171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2150925Medicaid
WV0093561000Medicaid
OHP01331374OtherRAILROAD MEDICARE - MHCPI
WV9371911Medicare PIN
OH2150925Medicaid
OHP01331374OtherRAILROAD MEDICARE - MHCPI
G73568Medicare UPIN
OHH053500Medicare PIN