Provider Demographics
NPI:1588626709
Name:MEYER, CARL E (DO)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:E
Last Name:MEYER
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 1:3512 STATE ROUTE 257
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-2946
Mailing Address - Country:US
Mailing Address - Phone:814-677-3717
Mailing Address - Fax:814-677-8914
Practice Address - Street 1:3512 STATE ROUTE 257
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2946
Practice Address - Country:US
Practice Address - Phone:814-677-3717
Practice Address - Fax:814-677-8914
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003941L207QA0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008052990003Medicaid
PA0008052990003Medicaid