Provider Demographics
NPI:1083612709
Name:MERWIN, BRUCE ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:MERWIN
Suffix:
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 1:5130 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9090
Mailing Address - Country:US
Mailing Address - Phone:740-455-9374
Mailing Address - Fax:
Practice Address - Street 1:620B MORRISON RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5327
Practice Address - Country:US
Practice Address - Phone:614-944-4770
Practice Address - Fax:614-944-4771
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052690M2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311294756005OtherMEDICAL MUTUAL
OH000000119478OtherANTHEM
OH029415600OtherBLACK LUNG
OH0703359Medicaid
OH360002962OtherRAILROAD MADICARE