MEDICARE: DR. JONATHAN S MYERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	25MA06114100	NJ
2	207W00000X	Ophthalmology Physician	C1005549	DE
3	207W00000X	Ophthalmology Physician	MD053800L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023013190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN S MYERS M.D.

Provider Business Mailing Address
First Line	:	840 WALNUT ST STE 1110
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5109
Country	:	US
Telephone Number	:	215-928-3197
Fax Number	:	215-928-0166

Provider Business Practice Location Address
First Line	:	840 WALNUT ST STE 1110
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5109
Country	:	US
Telephone Number	:	215-928-3197
Fax Number	:	215-928-0166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/24/2019

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