Provider Demographics
NPI:1609940873
Name:MERLINO, LINA RITA (MD)
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:RITA
Last Name:MERLINO
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 1:341 PORT RICHMOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302
Mailing Address - Country:US
Mailing Address - Phone:718-981-6558
Mailing Address - Fax:718-720-8877
Practice Address - Street 1:341 PORT RICHMOND AVENUE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302
Practice Address - Country:US
Practice Address - Phone:718-981-6558
Practice Address - Fax:718-720-8877
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2018-05-14
Deactivation Date:2018-03-02
Deactivation Code:
Reactivation Date:2018-05-14
Provider Licenses
StateLicense IDTaxonomies
NY079194208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B02389Medicare UPIN