Provider Demographics
NPI:1154655694
Name:COUSINS, MERRIE DOROTHEA (DO)
Entity Type:Individual
Prefix:DR
First Name:MERRIE
Middle Name:DOROTHEA
Last Name:COUSINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11279 PERRY HWY STE 450
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9303
Mailing Address - Country:US
Mailing Address - Phone:724-933-1100
Mailing Address - Fax:724-933-1160
Practice Address - Street 1:603 WASHINGTON RD STE 300
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228
Practice Address - Country:US
Practice Address - Phone:412-563-6151
Practice Address - Fax:412-344-3780
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017474208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics