Provider Demographics
NPI:1518980390
Name:MERRITT, WINIFRED ANN (MD)
Entity Type:Individual
Prefix:
First Name:WINIFRED
Middle Name:ANN
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SEVER ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2194
Mailing Address - Country:US
Mailing Address - Phone:508-792-5564
Mailing Address - Fax:508-755-8093
Practice Address - Street 1:30 SEVER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2194
Practice Address - Country:US
Practice Address - Phone:508-792-5564
Practice Address - Fax:508-755-8093
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA473702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAME J05385Medicare ID - Type Unspecified