Provider Demographics
NPI:1861494619
Name:MERCER, MATTHEW (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:MERCER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 RADFORD ST NE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7858
Mailing Address - Country:US
Mailing Address - Phone:330-499-5840
Mailing Address - Fax:330-499-5840
Practice Address - Street 1:1431 RADFORD ST NE
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7858
Practice Address - Country:US
Practice Address - Phone:330-499-5840
Practice Address - Fax:330-499-5840
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH223167367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0887983Medicaid
OHME8213686Medicare ID - Type Unspecified