1871694091 NPI number — DR. WYNDELL HUNT MERRITT MD

Table of content: DR. LOVELY THANKACHAN (NPI 1073114492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871694091 NPI number — DR. WYNDELL HUNT MERRITT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERRITT
Provider First Name:
WYNDELL
Provider Middle Name:
HUNT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871694091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7660 E PARHAM RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
HENRICO
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23294-4378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-282-2112
Provider Business Mailing Address Fax Number:
804-282-7133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7660 E PARHAM RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HENRICO
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23294-4378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-282-2112
Provider Business Practice Location Address Fax Number:
804-282-7133
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  15121 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0105X , with the licence number: 0101026492 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 220987 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 240007986 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: AS07523600001 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 149330400 . This is a "US DEPARTMENT LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 220987 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005673 . This is a "ANTHEM BX" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0004137182 . This is a "AETNA INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42220 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6943420 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1300002 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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