Healthcare Provider Details

I. General information

NPI: 1588626709
Provider Name (Legal Business Name): CARL E MEYER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 STATE ROUTE 257
SENECA PA
16346-2946
US

IV. Provider business mailing address

3512 STATE ROUTE 257
SENECA PA
16346-2946
US

V. Phone/Fax

Practice location:
  • Phone: 814-677-3717
  • Fax: 814-677-8914
Mailing address:
  • Phone: 814-677-3717
  • Fax: 814-677-8914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberOS003941L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS003941L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: