Provider Demographics
NPI:1083875231
Name:MYERS, CHARISSA GARDNER (MD)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:GARDNER
Last Name:MYERS
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 1:700 S HENDERSON RD STE 306
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4208
Mailing Address - Country:US
Mailing Address - Phone:610-265-0726
Mailing Address - Fax:601-265-3132
Practice Address - Street 1:700 S HENDERSON RD STE 306
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4208
Practice Address - Country:US
Practice Address - Phone:610-265-0726
Practice Address - Fax:601-265-3132
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine