Provider Demographics
NPI:1083631618
Name:MEYERS, EDWARD JULIAN (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JULIAN
Last Name:MEYERS
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 1:325 BROAD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4167
Mailing Address - Country:US
Mailing Address - Phone:803-773-5227
Mailing Address - Fax:803-753-9312
Practice Address - Street 1:325 BROAD ST STE 100
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4167
Practice Address - Country:US
Practice Address - Phone:803-773-5227
Practice Address - Fax:803-753-9312
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28747207P00000X, 208D00000X
OH79801207P00000X
VA0101236147207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCI263838286OtherMEDICARE PROVIDER ID #
SC200071983OtherEIN
SC5568090001Medicare NSC
SCI26383Medicare UPIN
SCI263838286OtherMEDICARE PROVIDER ID #