Provider Demographics
NPI:1609962547
Name:MCKENZIE, MERRILL B (MD)
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:B
Last Name:MCKENZIE
Suffix:
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 1:501 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268
Mailing Address - Country:US
Mailing Address - Phone:717-765-3400
Mailing Address - Fax:717-765-3408
Practice Address - Street 1:501 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268
Practice Address - Country:US
Practice Address - Phone:717-765-4000
Practice Address - Fax:717-765-3447
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035052E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
930088503OtherMEDICARE RAILROAD
PA1364074OtherHIGHMARK BLUE SHIELD
PA2056466000OtherINDEPENDENCE BLUE CROSS
PA20015310Medicaid
097176GZ5Medicare PIN
PA1364074OtherHIGHMARK BLUE SHIELD