Provider Demographics
NPI:1063464642
Name:MYERS, RUSSELL H (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:H
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 1:3000 WATERCOVE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3982
Mailing Address - Country:US
Mailing Address - Phone:804-744-0200
Mailing Address - Fax:804-744-8417
Practice Address - Street 1:3000 WATERCOVE RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3982
Practice Address - Country:US
Practice Address - Phone:804-744-0200
Practice Address - Fax:804-744-8417
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5633834Medicaid
VA540883363OtherPHCS
VA540883363OtherFIRST HEALTH/CCN
VA540189OtherAETNA
VA5450883363OtherVIRGINIA HEALTH NETWORK
VA116048OtherANTHEM
VA540883363OtherGREAT WEST HEALTHCARE
VA10489OtherCIGNA
VA540883363OtherCHAMPUS-TRICARE
VA540883363OtherPREFERRED CARE
VA82538OtherSOUTHERN HEALTH
VA856732OtherMAMSI
VA0100410OtherUNITED HEALTHCARE
VA10002820OtherOPTIMA
VA10002820OtherOPTIMA
VA540883363OtherCHAMPUS-TRICARE
VA540883363OtherFIRST HEALTH/CCN
VA540883363OtherGREAT WEST HEALTHCARE
VAVAA104295Medicare PIN
VA016347V27Medicare PIN