Provider Demographics
NPI:1033285333
Name:MEYERS, KATHARINE (MD)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:MEYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2451
Mailing Address - Country:US
Mailing Address - Phone:203-327-9321
Mailing Address - Fax:203-967-2140
Practice Address - Street 1:1450 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2451
Practice Address - Country:US
Practice Address - Phone:203-327-9321
Practice Address - Fax:203-967-2140
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110008587Medicare ID - Type Unspecified
CTH60629Medicare UPIN