Healthcare Provider Details

I. General information

NPI: 1902465735
Provider Name (Legal Business Name): JORDAN GENE MEYERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LIBERTY SQ # 6049
BOSTON MA
02109-5800
US

IV. Provider business mailing address

6 LIBERTY SQ # 6049
BOSTON MA
02109-5800
US

V. Phone/Fax

Practice location:
  • Phone: 857-244-0119
  • Fax: 855-651-0589
Mailing address:
  • Phone: 857-244-0119
  • Fax: 855-651-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101285287
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number340721
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61468187
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD489287
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: