Provider Demographics
NPI:1225353477
Name:MEYER, DAVID STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:STEPHEN
Last Name:MEYER
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 1:607 S GENERALS BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3658
Mailing Address - Country:US
Mailing Address - Phone:704-736-9188
Mailing Address - Fax:704-736-9667
Practice Address - Street 1:607 S GENERALS BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092
Practice Address - Country:US
Practice Address - Phone:704-736-9188
Practice Address - Fax:704-736-9667
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00592207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1225353477Medicaid
NCNCE089BMedicare PIN
NCNCE089AMedicare PIN