Provider Demographics
NPI:1841320926
Name:MERRILL, ROBERT N (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:N
Last Name:MERRILL
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 1:821 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4243
Mailing Address - Country:US
Mailing Address - Phone:207-596-7148
Mailing Address - Fax:207-596-7154
Practice Address - Street 1:821 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4243
Practice Address - Country:US
Practice Address - Phone:207-596-7148
Practice Address - Fax:207-596-7154
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME12983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEBX2589Medicare PIN
ME080018878Medicare PIN
MEB74890Medicare UPIN