Provider Demographics
NPI:1285012765
Name:MERGOLD INC
Entity Type:Organization
Organization Name:MERGOLD INC
Other - Org Name:HALETHORPE PHARMACY DIABETES SELF MANAGEMENT EDUCATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GARMER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-247-3344
Mailing Address - Street 1:1307 FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3913
Mailing Address - Country:US
Mailing Address - Phone:410-247-3344
Mailing Address - Fax:410-247-9110
Practice Address - Street 1:1307 FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-3913
Practice Address - Country:US
Practice Address - Phone:410-247-3344
Practice Address - Fax:410-247-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP02423174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405657400Medicaid
MD612048OtherDIABETES EDUCATION ACCREDITATIONPROGRAM / AADE
MD5140800001Medicare PIN