Provider Demographics
NPI:1275528275
Name:GLADDEN, MERRILL LEE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MERRILL
Middle Name:LEE
Last Name:GLADDEN
Suffix:JR
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 1:1215 RIDGEWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2694
Mailing Address - Country:US
Mailing Address - Phone:419-352-1519
Mailing Address - Fax:419-352-7004
Practice Address - Street 1:1215 RIDGEWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2694
Practice Address - Country:US
Practice Address - Phone:419-352-1519
Practice Address - Fax:419-352-7004
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085092207XS0106X, 207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2505041OtherUNITED HEALTHCARE
OH7073656OtherAETNA
OH04665OtherPARAMOUNT
OH2517637Medicaid
OH3678364OtherAETNA HMO
OH000000350668OtherANTHEM
OH000000350668OtherANTHEM
OH04665OtherPARAMOUNT