Provider Demographics
NPI:1235751140
Name:MERZLAK, NICOLAS EVAN (DO)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:EVAN
Last Name:MERZLAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20397 ROUTE 19 STE 330
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6133
Mailing Address - Country:US
Mailing Address - Phone:724-772-3300
Mailing Address - Fax:724-772-3360
Practice Address - Street 1:20397 ROUTE 19 STE 330
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6133
Practice Address - Country:US
Practice Address - Phone:724-772-3300
Practice Address - Fax:724-772-3360
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS022853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty