Provider Demographics
NPI:1972828341
Name:MYERS, ALICIA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:MYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MYERS
Other - Last Name:LAGASCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2390 HEMBY LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3775
Practice Address - Country:US
Practice Address - Phone:252-744-4500
Practice Address - Fax:252-744-5713
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC186779207R00000X
VA0116022397207R00000X
NC2015-00041207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19CP2OtherBCBS NC
NC1972828341Medicaid
NCNCO004AMedicare PIN