1689879603 NPI number — DR. DONALD RUSSELL MERRYFIELD DDS

Table of content: DR. DONALD RUSSELL MERRYFIELD DDS (NPI 1689879603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689879603 NPI number — DR. DONALD RUSSELL MERRYFIELD DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERRYFIELD
Provider First Name:
DONALD
Provider Middle Name:
RUSSELL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1689879603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10545 TODDS CORNER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21601-5437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-763-8432
Provider Business Mailing Address Fax Number:
410-763-8432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 VARNUM ST NE
Provider Second Line Business Practice Location Address:
#006 DE PAUL BLDG PROVIDENCE HOSPITAL
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-269-7103
Provider Business Practice Location Address Fax Number:
202-269-7100
Provider Enumeration Date:
06/19/2007

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: 1223X0400X , with the licence number:  DEN2274 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X , with the licence number: 4423 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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