Provider Demographics
NPI:1891045712
Name:DR. CAROLYN MERRITT, PLLC
Entity Type:Organization
Organization Name:DR. CAROLYN MERRITT, PLLC
Other - Org Name:CAROLYN MERRITT MD & ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:LAVON
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-778-7546
Mailing Address - Street 1:PO BOX 5240
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00851-5240
Mailing Address - Country:US
Mailing Address - Phone:340-778-7546
Mailing Address - Fax:
Practice Address - Street 1:254-A ESTATE GLYNN # 3 & 4
Practice Address - Street 2:RR 1 6198
Practice Address - City:KINGSHILL
Practice Address - State:VI
Practice Address - Zip Code:00850-6198
Practice Address - Country:US
Practice Address - Phone:340-778-7546
Practice Address - Fax:340-778-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1247174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherPTAN
PENDINGOtherPTAN
VIB05100Medicare UPIN