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NPI Code Detail

MEDICARE: DR. CHARLES R. MYERS PH. D.

MEDICARE: DR. CHARLES R. MYERS PH. 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
1103TC2200XClinical Child & Adolescent Psychologist048.0000691VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1048.0000691OTHERVTSTATE OF VT BOARD OF PSYCHOLOGICAL EXAMINERS PSYCHOLOGIST -DOCTORATE

General Provider Information

NPI Number : 1669990529
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES R. MYERS PH. D.
Provider Business Mailing Address
First Line : 30 AIRPORT RD
Second Line :
City : SOUTH BURLINGTON
State : VT
Zip : 05403-6432
Country : US
Telephone Number : 802-658-0040
Fax Number : 802-658-0216
Provider Business Practice Location Address
First Line : 30 AIRPORT RD
Second Line :
City : SOUTH BURLINGTON
State : VT
Zip : 05403-6432
Country : US
Telephone Number : 802-658-0040
Fax Number : 802-658-0216
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2017
Last Update Date : 07/21/2022

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