Provider Demographics
NPI:1225097769
Name:MEYERS, CHARLES L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
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 1:501 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1252
Mailing Address - Country:US
Mailing Address - Phone:610-594-6660
Mailing Address - Fax:610-594-6810
Practice Address - Street 1:501 GORDON DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1252
Practice Address - Country:US
Practice Address - Phone:610-594-6660
Practice Address - Fax:610-594-6810
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425728207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3828750OtherAETNA HEALTH PLANS
PA2405639000OtherINDEPENDENCE BLUE CROSS
PA1738866OtherPENNSYLVANIA BLUE SHIELD
PA088454RH0Medicare PIN
PA2405639000OtherINDEPENDENCE BLUE CROSS