Provider Demographics
NPI:1801879937
Name:MERENDA, GLORIA OWEN (MD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:OWEN
Last Name:MERENDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 795083
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0795
Mailing Address - Country:US
Mailing Address - Phone:314-821-8055
Mailing Address - Fax:314-821-1833
Practice Address - Street 1:6420 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-768-8202
Practice Address - Fax:314-768-7145
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2011-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR4D62207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1101345OtherUNITED HEALTH CARE
MO33114OtherBLUE CROSS BLUE SHIELD
MO042938OtherHEALTH ALLIANCE
MO209982107Medicaid
MO220024456OtherTRAVELERS
MO102058OtherHEALTHLINK
MOE39557OtherMERCY
29381OtherGROUP HEALTH PLAN/ADVANTR
MO33114OtherBLUE CROSS BLUE SHIELD
MO1101345OtherUNITED HEALTH CARE