Provider Demographics
NPI:1093934655
Name:PERSILA V. MERTZ, M.D., P.C.
Entity Type:Organization
Organization Name:PERSILA V. MERTZ, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERSILA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-733-3600
Mailing Address - Street 1:115 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2710
Mailing Address - Country:US
Mailing Address - Phone:717-733-3600
Mailing Address - Fax:717-721-3038
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2710
Practice Address - Country:US
Practice Address - Phone:717-733-3600
Practice Address - Fax:717-721-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043167E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110758OtherMEDICARE LEGACY NUMBER
093980OtherMEDICARE PROVIDER NUMBER
1942262019OtherINDIVIDUAL NPI
110758OtherMEDICARE PTAN
093980OtherMEDICARE PROVIDER NUMBER
PAF32135Medicare UPIN