Provider Demographics
NPI:1629023833
Name:MERSON, MARK HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HAROLD
Last Name:MERSON
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:PO BOX 17978
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-7978
Mailing Address - Country:US
Mailing Address - Phone:804-289-4937
Mailing Address - Fax:
Practice Address - Street 1:2621 GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4300
Practice Address - Country:US
Practice Address - Phone:804-254-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044518207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010027373Medicaid
VA022647A17Medicare PIN
VA010027373Medicaid
P00703269Medicare PIN
VA00X968C06Medicare PIN