Provider Demographics
NPI:1629009204
Name:MYERS, HERBERT E (MD)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:E
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:HARMAN
Mailing Address - State:WV
Mailing Address - Zip Code:26270-0171
Mailing Address - Country:US
Mailing Address - Phone:717-475-0969
Mailing Address - Fax:
Practice Address - Street 1:39 CORTLAND ACRES LN
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:WV
Practice Address - Zip Code:26292-8018
Practice Address - Country:US
Practice Address - Phone:304-463-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV116952084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017805880001Medicaid
158639GHEMedicare ID - Type Unspecified
PA0017805880001Medicaid