Provider Demographics
NPI:1295989903
Name:MEYER, EDWIN WALTER
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:WALTER
Last Name:MEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 572
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:VA
Mailing Address - Zip Code:24070-9507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 572
Practice Address - Street 2:
Practice Address - City:CATAWBA
Practice Address - State:VA
Practice Address - Zip Code:24070-9507
Practice Address - Country:US
Practice Address - Phone:540-864-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705060218A171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications