Provider Demographics
NPI:1154308435
Name:MERTEN, GREGORY J (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:MERTEN
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 1:1300 BAXTER ST STE 215
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3106
Mailing Address - Country:US
Mailing Address - Phone:704-332-0366
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:7903 PROVIDENCE RD STE 110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8300
Practice Address - Country:US
Practice Address - Phone:704-248-5101
Practice Address - Fax:704-971-0035
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-00256207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904085Medicaid
NC143TOOtherBCBS
NC143TOOtherBCBS
NC5904085Medicaid
NC2052821Medicare PIN