Provider Demographics
NPI:1073522066
Name:MAYERS, DOUGLAS LYTLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LYTLE
Last Name:MAYERS
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 1:9 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2458
Mailing Address - Country:US
Mailing Address - Phone:203-270-1551
Mailing Address - Fax:203-798-4336
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-295-4237
Practice Address - Fax:301-295-2992
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033418286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101033418OtherMEDICAL LICENSE
MI4301071658OtherMEDICAL LICENSE