Provider Demographics
NPI:1083753636
Name:MERIGIAN, KEVIN SAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SAM
Last Name:MERIGIAN
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:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-0205
Mailing Address - Country:US
Mailing Address - Phone:901-867-1018
Mailing Address - Fax:901-867-1065
Practice Address - Street 1:2849 COLLIERVILLE ARLINGTON N
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-9320
Practice Address - Country:US
Practice Address - Phone:901-867-1018
Practice Address - Fax:901-867-1065
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21904208U00000X, 209800000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4028971OtherBLUE CROSS BLUE SHIELD
TNA15606Medicare UPIN
TN3063798Medicare ID - Type UnspecifiedMEDICARE