Healthcare Provider Details

I. General information

NPI: 1982691580
Provider Name (Legal Business Name): SAMUEL K MERKHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 JEFFERSON HTS SUITE D107
CATSKILL NY
12414-1237
US

IV. Provider business mailing address

949 COLUMBIA ST
HUDSON NY
12534-2624
US

V. Phone/Fax

Practice location:
  • Phone: 518-943-1442
  • Fax: 518-943-2003
Mailing address:
  • Phone: 518-828-7188
  • Fax: 518-828-5049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number209006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: