Healthcare Provider Details

I. General information

NPI: 1114951076
Provider Name (Legal Business Name): JOHN FREDERICK MEYERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DIANE ELIZABETH PETTY LICSW

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 MAY ST. FAIRLAWN REHAB HOSP
WORCESTER MA
01602
US

IV. Provider business mailing address

150 DOYLE RD
HOLDEN MA
01520-2016
US

V. Phone/Fax

Practice location:
  • Phone: 508-791-6351
  • Fax: 508-754-2087
Mailing address:
  • Phone: 508-856-0888
  • Fax: 508-856-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number53933
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: