Provider Demographics
NPI:1235257957
Name:MERRITT, CAROLYN LAVON (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:LAVON
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5240
Mailing Address - Street 2:SUITE 3 & 4
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00851-5240
Mailing Address - Country:US
Mailing Address - Phone:340-778-7546
Mailing Address - Fax:340-778-7543
Practice Address - Street 1:4031 ESTATE LAGRANDE PRINCESS
Practice Address - Street 2:SUITE 35
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4375
Practice Address - Country:US
Practice Address - Phone:340-778-7546
Practice Address - Fax:340-778-7543
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1247207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI660642466OtherEIN
VI0022432Medicare ID - Type Unspecified
VIB05100Medicare UPIN