Provider Demographics
NPI:1184766891
Name:MERRITT, BELINDA A (MD)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:A
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BELINDA
Other - Middle Name:A
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-0013
Mailing Address - Country:US
Mailing Address - Phone:731-587-5963
Mailing Address - Fax:731-587-1941
Practice Address - Street 1:180 MOUNT PELIA RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3812
Practice Address - Country:US
Practice Address - Phone:731-587-4231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0021024208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4059875OtherBLUE CROSS
TN3880609Medicaid
TNP00019505Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TN3880609Medicaid
TNC43031Medicare UPIN