Provider Demographics
NPI:1902035215
Name:MERLO, LOURDES GRICEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:GRICEL
Last Name:MERLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:65-45 SAUNDERS STREET
Mailing Address - Street 2:6F
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:917-536-2009
Mailing Address - Fax:718-275-4212
Practice Address - Street 1:65-45 SAUNDERS STREET
Practice Address - Street 2:6F
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:917-536-2009
Practice Address - Fax:718-275-4212
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY254093207RH0002X
CT046637207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine