Provider Demographics
NPI:1629156880
Name:MYERS, JEFFREY C (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:C
Last Name:MYERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:717-299-1928
Mailing Address - Fax:717-517-5030
Practice Address - Street 1:2600 GLASGOW AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4773
Practice Address - Country:US
Practice Address - Phone:302-836-8350
Practice Address - Fax:717-517-5030
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC50000480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031803OtherHEALTHAMERICA/HEALTHASSURANCE
PA50086906OtherCAPITAL BLUECROSS
PA1031803OtherHEALTHAMERICA/HEALTHASSURANCE
Q49080Medicare UPIN