Provider Demographics
NPI:1811997927
Name:MEYER, GREGG STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:STEPHEN
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:ONE MEDICAL CENTER DRIVE
Mailing Address - Street 2:LEVEL 5: BUILDING 3, ADMINISTRATION
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756
Mailing Address - Country:US
Mailing Address - Phone:603-650-6366
Mailing Address - Fax:603-650-7440
Practice Address - Street 1:18 OLD ETNA RD
Practice Address - Street 2:DHMC INTERNAL MEDICINE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:603-650-4000
Practice Address - Fax:603-650-4190
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72444207R00000X
NH15764207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH32001589Medicaid
VT1020852Medicaid
MA3102106Medicaid
MA724119OtherTUFTS HEALTH PLAN
MAJ13020OtherBCBS
MAJ13020Medicare PIN
NHJ1302003Medicare PIN
NH32001589Medicaid
NHJ1302002Medicare PIN