Provider Demographics
NPI:1831187962
Name:MEYERS, MITCHELL SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:SCOTT
Last Name:MEYERS
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 1:1425 PORTER ST
Mailing Address - Street 2:USAMRIID (MCMR-UIM-O)
Mailing Address - City:FORT DETRICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-9211
Mailing Address - Country:US
Mailing Address - Phone:301-619-4996
Mailing Address - Fax:301-619-2511
Practice Address - Street 1:1425 PORTER ST
Practice Address - Street 2:USAMRIID
Practice Address - City:FORT DETRICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-619-4996
Practice Address - Fax:301-619-2511
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD95892083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine