Provider Demographics
NPI:1063517159
Name:MEYERS, MARY CASSEBAUM (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CASSEBAUM
Last Name:MEYERS
Suffix:
Gender:F
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 1337
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-1337
Mailing Address - Country:US
Mailing Address - Phone:276-236-0065
Mailing Address - Fax:
Practice Address - Street 1:106 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2276
Practice Address - Country:US
Practice Address - Phone:276-236-0065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101042251208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA182177OtherANTHEM
NCE0834OtherMEDCOST
VA010159148Medicaid
VA305707OtherSOUTHERN HEALTH
NC8308332OtherCIGNA NC