Provider Demographics
NPI:1710331723
Name:MYERS, CARLIE (MD)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE CINCINNATI
Mailing Address - Street 2:ML 2005
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4259
Mailing Address - Fax:513-636-4267
Practice Address - Street 1:3333 BURNET AVE CINCINNATI
Practice Address - Street 2:ML 2005
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4259
Practice Address - Fax:513-636-4267
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD870822080P0204X
OH35.1452142080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine