Provider Demographics
NPI:1013936772
Name:MEYERSON, MARTIN BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:BENJAMIN
Last Name:MEYERSON
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:PO BOX 4574
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-1574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1988 S 16TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6647
Practice Address - Country:US
Practice Address - Phone:910-251-1839
Practice Address - Fax:910-251-8286
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21687174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
920002731OtherRAILROAD MEDICARE
NC8958774Medicaid
58774OtherBCBS
24-20130OtherUNITED HEALTHCARE
59536OtherMEDCOST
59536OtherMEDCOST
C80957Medicare UPIN
NC8958774Medicaid