Provider Demographics
NPI:1376598227
Name:MEYER, GRETCHEN A (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:A
Last Name:MEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRETHEN
Other - Middle Name:M
Other - Last Name:LABAROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 421718
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-4203
Mailing Address - Country:US
Mailing Address - Phone:843-652-8226
Mailing Address - Fax:
Practice Address - Street 1:2405 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-7764
Practice Address - Country:US
Practice Address - Phone:843-652-3600
Practice Address - Fax:843-881-5012
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20430207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134N1Medicaid
NC89134N1Medicaid
NC2014265Medicare ID - Type Unspecified