Provider Demographics
NPI:1013992908
Name:MEYER, WAYNE LEWIS (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:LEWIS
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9715 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6304
Mailing Address - Country:US
Mailing Address - Phone:301-294-2955
Mailing Address - Fax:301-294-6499
Practice Address - Street 1:9715 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 214
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6304
Practice Address - Country:US
Practice Address - Phone:301-294-2955
Practice Address - Fax:301-294-6499
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD31840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C62829Medicare UPIN
ME480788Medicare ID - Type Unspecified