Provider Demographics
NPI:1225038805
Name:MERRILL, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MERRILL
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 1:69 US ROUTE 1
Mailing Address - Street 2:6 NONESUCH RD
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9374
Mailing Address - Country:US
Mailing Address - Phone:207-883-8100
Mailing Address - Fax:
Practice Address - Street 1:69 US ROUTE 1
Practice Address - Street 2:6 NONESUCH RD
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9374
Practice Address - Country:US
Practice Address - Phone:207-883-8100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME008986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEDO3871Medicare UPIN
MP309220Medicare ID - Type Unspecified