Provider Demographics
NPI:1760478697
Name:MIRMAN, MERRILL JAY (DO)
Entity Type:Individual
Prefix:DR
First Name:MERRILL
Middle Name:JAY
Last Name:MIRMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5606
Mailing Address - Country:US
Mailing Address - Phone:610-361-7878
Mailing Address - Fax:
Practice Address - Street 1:14 BONNIE LN
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5606
Practice Address - Country:US
Practice Address - Phone:610-361-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP024664L183500000X
PAOS002340L208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD98575Medicare UPIN