Provider Demographics
NPI:1508050899
Name:MYERS, TERESA ANN (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 ASHFORD DR
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-3157
Mailing Address - Country:US
Mailing Address - Phone:216-905-6293
Mailing Address - Fax:330-576-6559
Practice Address - Street 1:4065 CENTER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2918
Practice Address - Country:US
Practice Address - Phone:330-558-0070
Practice Address - Fax:330-558-0077
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-118960207Q00000X
OH35093985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2981546Medicaid
IL036118960Medicaid
OH4274052OtherMEDICARE ID
ILK44287Medicare PIN