Provider Demographics
NPI:1891804555
Name:MERRITT, VIRGINIA (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:MERRITT
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 1:190 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2540
Mailing Address - Country:US
Mailing Address - Phone:617-969-5493
Mailing Address - Fax:
Practice Address - Street 1:63 FOUNTAIN ST STE 402
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6280
Practice Address - Country:US
Practice Address - Phone:508-872-4813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA603462084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ08163Medicare PIN
MAD87961Medicare UPIN