Provider Demographics
NPI:1700818358
Name:MEYER, JENNIFER ADELE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ADELE
Last Name:MEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ADELE
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2713 DANTZLER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9005
Mailing Address - Country:US
Mailing Address - Phone:843-764-1722
Mailing Address - Fax:843-764-1788
Practice Address - Street 1:2713 DANTZLER DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9005
Practice Address - Country:US
Practice Address - Phone:843-764-1722
Practice Address - Fax:813-764-1788
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428460208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7742816OtherAETNA NON-HMO
PAP008245OtherGATEWAY HEALTH PLAN
PA1016977600001Medicaid
PA1399083OtherAETNA HMO
PA1869071OtherHIGHMARK BLUE SHIELD
PAI54909OtherHEALTH AMERICA
PA100765 S1BXOtherGEISINGER HEALTH PLAN
PA20058917OtherAMERIHEALTH MERCY HEALTH
PA50059521OtherCAPITAL BLUE CROSS
PA20058917OtherAMERIHEALTH MERCY HEALTH
PAI54909Medicare UPIN