Provider Demographics
NPI:1972552545
Name:MEYERLE, JON HAMILTON (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:HAMILTON
Last Name:MEYERLE
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 1:220 GLENN RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2512
Mailing Address - Country:US
Mailing Address - Phone:202-246-3262
Mailing Address - Fax:610-200-1411
Practice Address - Street 1:32 PARKING PLZ STE 300
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003
Practice Address - Country:US
Practice Address - Phone:610-299-4561
Practice Address - Fax:610-200-1411
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62336207N00000X
PAMD464849207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407240500Medicaid
PA103577690-0003Medicaid
MDH766JOMedicare ID - Type UnspecifiedGROUP
MD407240500Medicaid