Provider Demographics
NPI:1114990207
Name:MERRITT, CLINTON T (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:T
Last Name:MERRITT
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 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5162
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-932-4075
Practice Address - Fax:540-932-5199
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234711208M00000X
AZ52553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA90408OtherOPTIMA
VA010067065Medicaid
VA5084062OtherCIGNA
VA236708OtherSOUTHERN HEALTH
VA136872OtherANTHEM
VA10067065OtherVA PREMIER
VA2237898OtherFIRST HEALTH
VA2237898OtherFIRST HEALTH
VA005767A75Medicare PIN
VA90408OtherOPTIMA
VA236708OtherSOUTHERN HEALTH
VAC02675Medicare PIN
VA136872OtherANTHEM