Provider Demographics
NPI:1780662049
Name:MERSCH, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:MERSCH
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 1:701 10TH STREET SE
Mailing Address - Street 2:LEVEL 4, LUNDY PAVILION
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403
Mailing Address - Country:US
Mailing Address - Phone:319-861-7900
Mailing Address - Fax:319-861-7950
Practice Address - Street 1:701 10TH STREET SE
Practice Address - Street 2:LEVEL 4, LUNDY PAVILION
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403
Practice Address - Country:US
Practice Address - Phone:319-861-7900
Practice Address - Fax:319-861-7950
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35830208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0442962Medicaid
IA1780662049Medicaid
IAI13090Medicare ID - Type Unspecified
IA1780662049Medicaid