Provider Demographics
NPI:1801163597
Name:WYNDELL H MERRITT MD PC
Entity type:Organization
Organization Name:WYNDELL H MERRITT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:WYNDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-282-2112
Mailing Address - Street 1:7660 E PARHAM RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4378
Mailing Address - Country:US
Mailing Address - Phone:804-282-2112
Mailing Address - Fax:804-282-7133
Practice Address - Street 1:7660 E PARHAM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4378
Practice Address - Country:US
Practice Address - Phone:804-282-2112
Practice Address - Fax:804-282-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB09324Medicare UPIN