Provider Demographics
NPI:1194857409
Name:MERION, JUDITH A (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:A
Last Name:MERION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:15 REAR CHURCH STREET, SUITE E1
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-0258
Mailing Address - Country:US
Mailing Address - Phone:508-696-9089
Mailing Address - Fax:914-779-3910
Practice Address - Street 1:15 REAR CHURCH STREET
Practice Address - Street 2:SUITE E-1
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568
Practice Address - Country:US
Practice Address - Phone:508-696-9089
Practice Address - Fax:914-779-3910
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185785-12084P0800X, 2084P0804X
MA2344842084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01257616Medicaid
NY01257616Medicaid
NYE52870Medicare UPIN