Provider Demographics
NPI:1851456321
Name:MEYER, VINCENT EDWIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:EDWIN
Last Name:MEYER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:418 GEYSER RD
Mailing Address - Street 2:#14
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-6002
Mailing Address - Country:US
Mailing Address - Phone:518-584-5331
Mailing Address - Fax:518-584-5332
Practice Address - Street 1:418 GEYSER RD
Practice Address - Street 2:#14
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-6002
Practice Address - Country:US
Practice Address - Phone:518-584-5331
Practice Address - Fax:518-584-5332
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD1608Medicare ID - Type Unspecified
H65003Medicare UPIN