Provider Demographics
NPI:1023011673
Name:MYERS, TODD RICHARD (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:RICHARD
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 1:406 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2003
Mailing Address - Country:US
Mailing Address - Phone:740-516-8133
Mailing Address - Fax:740-568-0057
Practice Address - Street 1:1113 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1020
Practice Address - Country:US
Practice Address - Phone:740-516-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19171207Q00000X
OH35075798M207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01331374OtherRAILROAD MEDICARE - MHCPI
WV0093561000Medicaid
OH2150925Medicaid
WV9371911Medicare PIN
OH2150925Medicaid
OHP01331374OtherRAILROAD MEDICARE - MHCPI
G73568Medicare UPIN
OHH053500Medicare PIN