Provider Demographics
NPI:1922162262
Name:MERRELL, NATHANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:J
Last Name:MERRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2253
Mailing Address - Country:US
Mailing Address - Phone:978-840-6481
Mailing Address - Fax:978-840-0506
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2253
Practice Address - Country:US
Practice Address - Phone:978-840-6481
Practice Address - Fax:978-840-0506
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA72557208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3108708Medicaid
MAJ13543Medicare ID - Type Unspecified
MA3108708Medicaid