Provider Demographics
NPI:1235132200
Name:MEYERS, IRA DOUGLAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:DOUGLAS
Last Name:MEYERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 WELSH RD
Mailing Address - Street 2:STE 203
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6357
Mailing Address - Country:US
Mailing Address - Phone:215-938-7725
Mailing Address - Fax:215-938-7990
Practice Address - Street 1:727 WELSH RD
Practice Address - Street 2:STE 203
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6357
Practice Address - Country:US
Practice Address - Phone:215-938-7725
Practice Address - Fax:215-938-7990
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003131L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28873Medicare UPIN
PA115031Medicare ID - Type Unspecified
PA2033120001Medicare NSC