Provider Demographics
NPI:1710906136
Name:MERRIAM, LOUIS THAYER (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:THAYER
Last Name:MERRIAM
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 1:130 FISHER RD STE 3-1
Mailing Address - Street 2:BERLIN GENERAL SURGERY
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9000
Mailing Address - Country:US
Mailing Address - Phone:802-225-7039
Mailing Address - Fax:
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:SUITE 3-1
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-225-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212039208600000X
VT042.0012371208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1020429Medicaid
NY5372668OtherAETNA
NY77L071OtherEMPIRE BC.BS
NY01881158Medicaid
NY77L071Medicare ID - Type Unspecified
VT1020429Medicaid