Healthcare Provider Details

I. General information

NPI: 1891804555
Provider Name (Legal Business Name): VIRGINIA MERRITT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 FOUNTAIN ST STE 402
FRAMINGHAM MA
01702-6280
US

IV. Provider business mailing address

190 JACKSON ST
NEWTON CENTER MA
02459-2540
US

V. Phone/Fax

Practice location:
  • Phone: 508-872-4813
  • Fax:
Mailing address:
  • Phone: 617-969-5493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number60346
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: