Provider Demographics
NPI:1760437867
Name:NOOR M. MERCHANT MD & ASSOCIATES PA
Entity Type:Organization
Organization Name:NOOR M. MERCHANT MD & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUKAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-589-0879
Mailing Address - Street 1:13060 US HWY# 1
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958
Mailing Address - Country:US
Mailing Address - Phone:772-589-0879
Mailing Address - Fax:772-589-1935
Practice Address - Street 1:13060 US HWY# 1
Practice Address - Street 2:STE A
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958
Practice Address - Country:US
Practice Address - Phone:772-589-0879
Practice Address - Fax:772-589-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
FL800019720291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4984Medicare ID - Type UnspecifiedMEDICARE GROUP IDENTIFIER