Provider Demographics
NPI:1295725497
Name:MEYER, MATTHEW A (MD)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
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 1:2932 NATHANIELS RUN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-7501
Mailing Address - Country:US
Mailing Address - Phone:262-389-9050
Mailing Address - Fax:262-549-1657
Practice Address - Street 1:2932 NATHANIELS RUN
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-7501
Practice Address - Country:US
Practice Address - Phone:262-549-2229
Practice Address - Fax:262-549-1657
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19568-020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI387671751007OtherBLUE CROSS BLUE SHIELD
WI31215400Medicaid
WIB55065Medicare UPIN