Provider Demographics
NPI:1518933498
Name:MEYER, MICHAEL A (AD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MEYER
Suffix:
Gender:M
Credentials:AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5771
Mailing Address - Country:US
Mailing Address - Phone:716-631-3555
Mailing Address - Fax:716-891-2153
Practice Address - Street 1:400 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5771
Practice Address - Country:US
Practice Address - Phone:716-631-3555
Practice Address - Fax:716-631-9525
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4596212084N0400X
TNMD237042084N0400X
NY2194132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3079047Medicaid
NYG07820Medicare UPIN
TN3079047Medicaid