Provider Demographics
NPI:1043227499
Name:MEYER, LAURA W (DO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:W
Last Name:MEYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1854
Mailing Address - Country:US
Mailing Address - Phone:330-688-9918
Mailing Address - Fax:330-688-6338
Practice Address - Street 1:4465 DARROW RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1854
Practice Address - Country:US
Practice Address - Phone:330-688-9918
Practice Address - Fax:330-688-6338
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006620M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2091105Medicaid
G84164Medicare UPIN
0864238Medicare PIN