Provider Demographics
NPI:1194820282
Name:MISHCON, MERRIT JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:MERRIT
Middle Name:JONATHAN
Last Name:MISHCON
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 1:243 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03276-5112
Mailing Address - Country:US
Mailing Address - Phone:603-286-8907
Mailing Address - Fax:603-286-8860
Practice Address - Street 1:243 MAIN ST
Practice Address - Street 2:
Practice Address - City:TILTON
Practice Address - State:NH
Practice Address - Zip Code:03276-5112
Practice Address - Country:US
Practice Address - Phone:603-286-8907
Practice Address - Fax:603-286-8860
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6029173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH6879Medicare PIN