Provider Demographics
NPI:1740403468
Name:MERRITT, GINA MICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MICHELLE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:DO
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 E DIXON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6838
Practice Address - Country:US
Practice Address - Phone:980-487-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00326207RP1001X, 207RS0012X, 207RC0200X, 207RS0012X, 207RP1001X
NC201300326207RC0200X
CT045497207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1740403468Medicaid
SCNC1899Medicaid
CT045497OtherCT LICENSE
NCNCD519DMedicare PIN
NCNCD519BMedicare PIN
CT045497OtherCT LICENSE
NC1740403468Medicaid