Provider Demographics
NPI:1811966054
Name:MEYER, THOMAS LOWELL (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LOWELL
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:5177 MCCARTY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8764
Practice Address - Country:US
Practice Address - Phone:765-448-8488
Practice Address - Fax:765-448-1160
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046977A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000190585OtherANTHEM PROVIDER NUMBER
IN200166020Medicaid
IN10825592OtherCAQH NUMBER
IN9397321OtherPHCS PID NUMBER
IN815500CMedicare PIN
ING37181Medicare UPIN
IN815490QQMedicare PIN
IN440002068Medicare PIN
IN000000190585OtherANTHEM PROVIDER NUMBER