Provider Demographics
NPI:1245353507
Name:MEYER, DOUGLAS ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ROBERT
Last Name:MEYER
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 1:2103 FALL HILL AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3428
Mailing Address - Country:US
Mailing Address - Phone:540-361-1611
Mailing Address - Fax:540-361-4750
Practice Address - Street 1:2103 FALL HILL AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3428
Practice Address - Country:US
Practice Address - Phone:540-361-1611
Practice Address - Fax:540-361-4750
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044918207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-1914235 32921OtherMDIPA
VA801064OtherAFFORDABLE
VAN176OtherCARE FIRST BC BS
VA62-1290-5Medicaid
VA11558OtherNYLC
VA4115060OtherAETNA
VI232589OtherANTHEM BC BS
VAB55056Medicare UPIN