Healthcare Provider Details

I. General information

NPI: 1770844748
Provider Name (Legal Business Name): CRAIG H. MERMEL MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15285 SHANNON RD
LOS GATOS CA
95032-5755
US

IV. Provider business mailing address

15285 SHANNON RD
LOS GATOS CA
95032-5755
US

V. Phone/Fax

Practice location:
  • Phone: 224-522-0920
  • Fax:
Mailing address:
  • Phone: 224-522-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberA-150311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: