Provider Demographics
NPI:1922307990
Name:PHILIP O MERRITT M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PHILIP O MERRITT M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:O
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:818-863-4446
Mailing Address - Street 1:2816 ROWENA AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-4108
Mailing Address - Country:US
Mailing Address - Phone:818-243-0477
Mailing Address - Fax:
Practice Address - Street 1:1500 E CHEVY CHASE DR
Practice Address - Street 2:SUITE 401
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4152
Practice Address - Country:US
Practice Address - Phone:818-863-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty