Provider Demographics
NPI:1528045994
Name:MYERS, THOMAS C (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:MYERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1884
Mailing Address - Country:US
Mailing Address - Phone:330-926-3495
Mailing Address - Fax:330-926-5864
Practice Address - Street 1:4465 DARROW RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1884
Practice Address - Country:US
Practice Address - Phone:330-926-3495
Practice Address - Fax:330-926-5864
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201474207N00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010043182Medicaid
WV0517596Medicare ID - Type Unspecified
VA004989D28Medicare ID - Type Unspecified
VA010043182Medicaid