Provider Demographics
NPI:1114951076
Name:MEYERS, JOHN FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:MEYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:ELIZABETH
Other - Last Name:PETTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:150 DOYLE RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2016
Mailing Address - Country:US
Mailing Address - Phone:508-856-0888
Mailing Address - Fax:508-856-7425
Practice Address - Street 1:189 MAY ST.
Practice Address - Street 2:FAIRLAWN REHAB HOSP
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602
Practice Address - Country:US
Practice Address - Phone:508-791-6351
Practice Address - Fax:508-754-2087
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA539332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA310-0472Medicare UPIN
1-28804Medicare ID - Type Unspecified
MAF27454Medicare UPIN