Provider Demographics
NPI:1669584207
Name:MEYER, MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
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 1:6132 CAROLINA BEACH RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2788
Mailing Address - Country:US
Mailing Address - Phone:910-749-4749
Mailing Address - Fax:910-794-4943
Practice Address - Street 1:6132 CAROLINA BEACH RD
Practice Address - Street 2:SUITE 8
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2788
Practice Address - Country:US
Practice Address - Phone:910-749-4749
Practice Address - Fax:910-794-4943
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891029LMedicaid
NC2235952Medicare PIN
NCC24886Medicare UPIN