Provider Demographics
NPI:1649319419
Name:MERRITT, THOMAS LLEWELLYN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LLEWELLYN
Last Name:MERRITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:355 NW RICHMOND BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3101
Mailing Address - Country:US
Mailing Address - Phone:206-546-5181
Mailing Address - Fax:206-546-6575
Practice Address - Street 1:355 NW RICHMOND BEACH RD
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3101
Practice Address - Country:US
Practice Address - Phone:206-546-5181
Practice Address - Fax:206-546-6575
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0017815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0017185OtherWA STATE MD LICENSE #
WA0106233OtherMEDICARE WA
WA96822OtherWASHINGTON L&I
WAA06049Medicare UPIN