Provider Demographics
NPI:1285602862
Name:ELLER, MYRON EDWARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:MYRON
Middle Name:EDWARD
Last Name:ELLER
Suffix:JR
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 1:445 COMMONWEALTH BLVD E
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2014
Mailing Address - Country:US
Mailing Address - Phone:276-632-3841
Mailing Address - Fax:276-632-2437
Practice Address - Street 1:445 COMMONWEALTH BLVD E
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2014
Practice Address - Country:US
Practice Address - Phone:276-632-3841
Practice Address - Fax:276-632-2437
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005615585Medicaid
VA466796OtherANTHEM GROUP NUMBER
VA0103709OtherUNITED HEALTHCARE PROVIDE
VA080018160OtherRAILROAD MEDICARE NUMBER
VA005615585OtherVIRGINIA PREMIER
VA466798OtherANTHEM PROVIDER NUMBER
VA2128061OtherMAMSI
VACB1505OtherRAILROAD MEDICARE GROUP #
VA0164ROtherBCBS OF NC COSTWISE
VA101806OtherCIGNA PROVIDER NUMBER
VA226029OtherSOUTHERN HEALTH PROVIDER
VA226029OtherSOUTHERN HEALTH PROVIDER
VACB1505OtherRAILROAD MEDICARE GROUP #
VA2128061OtherMAMSI