MEDICARE: LENA MERCHO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS042159	PA

General Provider Information

NPI Number	:	1942868443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENA MERCHO

Provider Business Mailing Address
First Line	:	1210 CHESTNUT ST UNIT 308
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4855
Country	:	US
Telephone Number	:	317-345-7809
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 W PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3029
Country	:	US
Telephone Number	:	215-372-0060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2019
Last Update Date	:	05/31/2019

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Directions to “ LENA MERCHO ” Practice Location

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