Provider Demographics
NPI:1922063593
Name:MERCHANT, WILSON III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILSON
Middle Name:
Last Name:MERCHANT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 STONY POINT DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-330-9105
Mailing Address - Fax:804-287-6119
Practice Address - Street 1:9101 STONY POINT DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-330-9105
Practice Address - Fax:804-287-6119
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101 035383208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080230000-00OtherQUALCHOICE
VA59337OtherSOUTHERN HEALTH
VAC04008OtherMEDICARE GROUP #
VA1900070OtherUNITED HEALTHCARE
VA340009882OtherRAILROAD MEDICARE
VA4063601OtherAETNA PPO
VA414884791OtherTRICARE
VA35757OtherALLIANCE
VA45728OtherSENTARA FAMILY CARE
VA790529OtherAETNA HMO
VACA4542OtherRAILROAD MEDICARE GROUP #
VA007500921Medicaid
VA207OtherCARENET
VA212761OtherCIGNA
VA007500921Medicaid