Provider Demographics
NPI:1720060429
Name:MYERS, MARY KAY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3735
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:1280 W CENTRAL ST STE 302
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3110
Practice Address - Country:US
Practice Address - Phone:774-462-3910
Practice Address - Fax:774-462-3911
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA249793207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110090983AMedicaid
NJ160035730OtherRAILROAD MCR #
MA002523401Medicare PIN
MA110090983AMedicaid