Healthcare Provider Details

I. General information

NPI: 1215976402
Provider Name (Legal Business Name): BARRY L. MYERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOSPITAL DR STE 223
GLEN BURNIE MD
21061-5707
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 443-221-2222
  • Fax:
Mailing address:
  • Phone: 804-968-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002711
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: