Provider Demographics
NPI:1841239662
Name:MYRICK, STEVEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:MYRICK
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 1:830 OLD LANCASTER RD.
Mailing Address - Street 2:SUITE 306 MOB NORTH
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:484-592-3000
Mailing Address - Fax:484-592-3009
Practice Address - Street 1:830 OLD LANCASTER RD.
Practice Address - Street 2:SUITE 306 MOB NORTH
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:484-592-3000
Practice Address - Fax:484-592-3009
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028778E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E81228Medicare UPIN
PA0012387290001Medicaid
PA0012387290004Medicaid
E81228Medicare UPIN
143170Medicare ID - Type Unspecified