Provider Demographics
NPI:1790719946
Name:MERRILL, CORINNE (MD)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 ANNE ST
Mailing Address - Street 2:
Mailing Address - City:N MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3601
Mailing Address - Country:US
Mailing Address - Phone:843-272-7397
Mailing Address - Fax:843-361-8635
Practice Address - Street 1:1007 ANNE ST
Practice Address - Street 2:
Practice Address - City:N MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3601
Practice Address - Country:US
Practice Address - Phone:843-272-7397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17411207Q00000X
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine