Provider Demographics
NPI:1104888007
Name:MEYER, JASON A (PA-C)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:A
Last Name:MEYER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE 520
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-571-8430
Mailing Address - Fax:410-573-5981
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 520
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-571-8430
Practice Address - Fax:410-573-5981
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC000221363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMM0839641OtherDEA
MD178LE577Medicare ID - Type Unspecified
MDMM0839641OtherDEA