Provider Demographics
NPI:1972587053
Name:MERRILL, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:MERRILL
Suffix:
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 1:8905 W LINCOLN AVE
Mailing Address - Street 2:#505
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2468
Mailing Address - Country:US
Mailing Address - Phone:414-329-5647
Mailing Address - Fax:
Practice Address - Street 1:8905 W LINCOLN AVE
Practice Address - Street 2:#505
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2468
Practice Address - Country:US
Practice Address - Phone:414-329-5647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701062207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6217281Medicaid
NCB8052OtherMEDCOST
NC1055ROtherBCBS
NC891055RMedicaid
NC19721OtherPARTNERS
WV3004936000Medicaid
7336411OtherAETNA
SCQ0106AMedicaid
NC1055ROtherBCBS