Healthcare Provider Details

I. General information

NPI: 1811997927
Provider Name (Legal Business Name): GREGG STEPHEN MEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD ETNA RD DHMC INTERNAL MEDICINE
LEBANON NH
03766
US

IV. Provider business mailing address

ONE MEDICAL CENTER DRIVE LEVEL 5: BUILDING 3, ADMINISTRATION
LEBANON NH
03756
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-4000
  • Fax: 603-650-4190
Mailing address:
  • Phone: 603-650-6366
  • Fax: 603-650-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number72444
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15764
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: