Provider Demographics
NPI:1245221662
Name:MYERS, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:MYERS
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 1:275 MAMMOTH RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4133
Mailing Address - Country:US
Mailing Address - Phone:603-663-8350
Mailing Address - Fax:603-663-8399
Practice Address - Street 1:275 MAMMOTH RD
Practice Address - Street 2:SUITE #1
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4133
Practice Address - Country:US
Practice Address - Phone:603-663-8350
Practice Address - Fax:603-663-8399
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9495208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP695104OtherOXFORD PIN
NH30008403Medicaid
NH1240729OtherUHC PIN
NH20092YOtherANTHEM REFERRING RAN
NH259710OtherCIGNA PIN
NHHLO003OtherHPHC PIN
NH520282OtherAETNA PIN
NH406451OtherTUFTS PIN
NH30008403Medicaid
NHHLO003OtherHPHC PIN