Provider Demographics
NPI:1770581951
Name:MYERS, CARLA M (DO)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:MYERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2510 COMMONS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3820
Mailing Address - Country:US
Mailing Address - Phone:937-429-0607
Mailing Address - Fax:937-558-3067
Practice Address - Street 1:2510 COMMONS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3820
Practice Address - Country:US
Practice Address - Phone:937-429-0607
Practice Address - Fax:937-558-3067
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34003506M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0539395Medicaid
OH311346460026OtherCARESOURCE
OH4246009OtherAETNA
OH000000016431OtherANTHEM
OH110066029OtherRR MEDICARE
OHH388280Medicare PIN
OH0539395Medicaid