Healthcare Provider Details

I. General information

NPI: 1215121397
Provider Name (Legal Business Name): KRISTIN SUZANNE MERGLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1898
US

IV. Provider business mailing address

7110 MONTGOMERY CO LINE RD
BROOKVILLE OH
45309-9639
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3433
  • Fax:
Mailing address:
  • Phone: 937-884-7198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.095483
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: