Provider Demographics
NPI:1023153509
Name:MERRELL, WOODSON (MD)
Entity type:Individual
Prefix:DR
First Name:WOODSON
Middle Name:
Last Name:MERRELL
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 1:44 E 67TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6135
Mailing Address - Country:US
Mailing Address - Phone:646-731-0120
Mailing Address - Fax:212-535-1172
Practice Address - Street 1:44 E 67TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6135
Practice Address - Country:US
Practice Address - Phone:646-731-0120
Practice Address - Fax:212-535-1172
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY131980OtherSTATE MEDICAL LICENSE NUMBER