Provider Demographics
NPI:1457037921
Name:MERION SQUARE ROAD MEDICAL P.C.
Entity Type:Organization
Organization Name:MERION SQUARE ROAD MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-453-0362
Mailing Address - Street 1:944 MERION SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035-1510
Mailing Address - Country:US
Mailing Address - Phone:646-598-8338
Mailing Address - Fax:
Practice Address - Street 1:9542 QUARRY BRIDGE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1917
Practice Address - Country:US
Practice Address - Phone:646-598-8338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health