Provider Demographics
NPI:1720036056
Name:MYERSCOUGH, RODNEY P (PHD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:P
Last Name:MYERSCOUGH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:ANNEX 3
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-375-7512
Mailing Address - Fax:330-375-3445
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:ANNEX 3
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1619
Practice Address - Country:US
Practice Address - Phone:330-375-7512
Practice Address - Fax:330-375-3445
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3819103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S29711Medicare UPIN
OH0946392Medicare ID - Type Unspecified
OHMYCP75762Medicare ID - Type Unspecified