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General NPI Number Information
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NPI Number | 1013043603
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Entity Type | Individual
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Provider Name | JOHN A MYERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 124 PROFESSORS ROW
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City | MEDFORD
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State | MA
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Zip | 02155-5816
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Country | US
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Telephone | 617-627-3350
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Fax |
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Provider Business Mailing Address
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Address Line | 742 FAIRHAVEN ROAD
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City | CONCORD
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State | MA
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Zip | 01742-4417
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Country | US
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Telephone | 617-627-3350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 43155
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License Number State | MA
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