MEDICARE: DR. VIVECA A MEYER MD

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	174400000X	Specialist	MD039176L	PA
2	2084P0804X	Child & Adolescent Psychiatry Physician	MD2016-0815	NM

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

General Provider Information

NPI Number	:	1215901012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVECA A MEYER MD

Provider Business Mailing Address
First Line	:	933 BRADBURY DR SE
Second Line	:	SUITE 2222
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4374
Country	:	US
Telephone Number	:	505-272-0148
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNM SOM DEPT OF PSYCHIATRY & BEHAVIORAL
Second Line	:	2400 TUCKER NE, 4TH FLOOR, MSC09 5030
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-0001
Country	:	US
Telephone Number	:	505-272-8043
Fax Number	:

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	12/15/2016

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Directions to “ DR. VIVECA A MEYER MD” Practice Location

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