Provider Demographics
NPI:1164656625
Name:MERRITT, MELISSA L (IDMT)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:L
Last Name:MERRITT
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 54 BOX 1559
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09601-0016
Mailing Address - Country:US
Mailing Address - Phone:0039043-430-6248
Mailing Address - Fax:
Practice Address - Street 1:31 MDG/MSGS
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09601
Practice Address - Country:US
Practice Address - Phone:0039043-430-6248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians