Provider Demographics
NPI:1235162967
Name:ADELAIDA MERKER D.O., P.C
Entity Type:Organization
Organization Name:ADELAIDA MERKER D.O., P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADELAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-677-6616
Mailing Address - Street 1:842 RED LION RD
Mailing Address - Street 2:UNIT 7
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1475
Mailing Address - Country:US
Mailing Address - Phone:215-677-6616
Mailing Address - Fax:215-677-6225
Practice Address - Street 1:842 RED LION RD
Practice Address - Street 2:UNIT 7
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1475
Practice Address - Country:US
Practice Address - Phone:215-677-6616
Practice Address - Fax:215-677-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS040658L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0078189220002Medicaid
PA063435Medicare ID - Type Unspecified