Provider Demographics
NPI:1710954219
Name:MERRILL, DOUGLAS G (MD, MBA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:G
Last Name:MERRILL
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIA
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-5922
Mailing Address - Fax:603-650-8980
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5922
Practice Address - Fax:603-650-8980
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14661207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0748467Medicaid
VT1017029Medicaid
WA8255556Medicaid
IA29542OtherWELLMARK BCBS
NH30209185Medicaid
WA5531MEOtherINDIVIDUAL BLUE SHIELD
WA050077267OtherRAIL ROAD MEDICARE
IA29542OtherWELLMARK BCBS
D37297Medicare UPIN
NH30209185Medicaid
IAP00434486Medicare PIN