Healthcare Provider Details

I. General information

NPI: 1710331723
Provider Name (Legal Business Name): CARLIE MYERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE CINCINNATI ML 2005
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE CINCINNATI ML 2005
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4259
  • Fax: 513-636-4267
Mailing address:
  • Phone: 513-636-4259
  • Fax: 513-636-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number35.145214
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberD87082
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: