Healthcare Provider Details

I. General information

NPI: 1477873131
Provider Name (Legal Business Name): AUDREY ANNE MERRIAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTURIAN DR SUITE 312
NEWARK DE
19713-2154
US

IV. Provider business mailing address

1 CENTURIAN DR SUITE 312
NEW HAVEN DE
19713-2154
US

V. Phone/Fax

Practice location:
  • Phone: 302-319-5680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number56527
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberC1-0011485
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC1-0011485
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: