Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 56QW5151 | PA |
NPI | 1356597850 |
---|---|
Provider Name | Dr. Rudolph Edward Merick |
First Address | Jeannette, PA 15644-6601 |
Second Address | Jeannette, PA 15644-6601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2008 |
Last Update Date | 30/09/2008 |