Provider Demographics
NPI:1023378296
Name:ANNE MERRA LLC
Entity Type:Organization
Organization Name:ANNE MERRA LLC
Other - Org Name:ANNE M MERRA MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-337-3257
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-0204
Mailing Address - Country:US
Mailing Address - Phone:207-337-3257
Mailing Address - Fax:
Practice Address - Street 1:10 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1680
Practice Address - Country:US
Practice Address - Phone:207-337-3257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH95692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1831138874Medicaid
NH3083427Medicaid
NH9569OtherLICENSE
MEMD15305OtherLICENSE
F32374OtherUPIN
F32374OtherUPIN