Healthcare Provider Details

I. General information

NPI: 1730640756
Provider Name (Legal Business Name): SCOTT JAMES MERRILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD STE 1900
NEWARK DE
19718-2200
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5000
  • Fax:
Mailing address:
  • Phone: 302-733-6510
  • Fax: 302-733-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD97561
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC1-0026163
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: