Healthcare Provider Details

I. General information

NPI: 1154634749
Provider Name (Legal Business Name): MARQUITTA BREANNA MERKISON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 M ST NW 4TH FLOOR
WASHINGTON DC
20037-1434
US

IV. Provider business mailing address

2300 M ST NW 4TH FLOOR
WASHINGTON DC
20037-1434
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-3275
  • Fax: 202-741-3277
Mailing address:
  • Phone: 202-741-3275
  • Fax: 202-741-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD0000112
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01201
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: