Healthcare Provider Details

I. General information

NPI: 1922307990
Provider Name (Legal Business Name): PHILIP O MERRITT M D A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E CHEVY CHASE DR SUITE 401
GLENDALE CA
91206-4152
US

IV. Provider business mailing address

2816 ROWENA AVE SUITE 4
LOS ANGELES CA
90039-4108
US

V. Phone/Fax

Practice location:
  • Phone: 818-863-4446
  • Fax:
Mailing address:
  • Phone: 818-243-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP O MERRITT
Title or Position: ORTHOPEDIC SURGEON
Credential: M.D.,
Phone: 818-863-4446