Provider Demographics
NPI:1679555825
Name:MELTZER, JEREMY BLAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:BLAIR
Last Name:MELTZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2688
Mailing Address - Country:US
Mailing Address - Phone:508-757-4160
Mailing Address - Fax:508-757-0627
Practice Address - Street 1:33 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2688
Practice Address - Country:US
Practice Address - Phone:508-757-4160
Practice Address - Fax:508-757-0627
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220115207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2042410Medicaid
MA2042410Medicaid
A36568Medicare ID - Type Unspecified