Provider Demographics
NPI:1164537007
Name:MERRITTS, GARY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WAYNE
Last Name:MERRITTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:91 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9702
Mailing Address - Country:US
Mailing Address - Phone:570-265-2191
Mailing Address - Fax:570-268-2244
Practice Address - Street 1:91 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-9702
Practice Address - Country:US
Practice Address - Phone:570-265-2191
Practice Address - Fax:570-268-2244
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD045524E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB69632Medicare UPIN