Provider Demographics
NPI:1750601688
Name:MEYLER, THOMAS STANISLAUS (M D)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STANISLAUS
Last Name:MEYLER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAYBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BELVEDERE
Mailing Address - State:CA
Mailing Address - Zip Code:94920-2380
Mailing Address - Country:US
Mailing Address - Phone:415-435-9285
Mailing Address - Fax:
Practice Address - Street 1:11 MAYBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BELVEDERE
Practice Address - State:CA
Practice Address - Zip Code:94920-2380
Practice Address - Country:US
Practice Address - Phone:415-435-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE239472085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAFE23947OtherCALIFORNIA LICENCE