Provider Demographics
NPI:1003164609
Name:MERCHANT, ROGER DALE
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:DALE
Last Name:MERCHANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2242
Mailing Address - Country:US
Mailing Address - Phone:540-943-0007
Mailing Address - Fax:
Practice Address - Street 1:1534 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2242
Practice Address - Country:US
Practice Address - Phone:540-943-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001610237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist