Healthcare Provider Details

I. General information

NPI: 1598967663
Provider Name (Legal Business Name): WILLIAM ANTHONY MERVAR CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15849 ARBOR TRL
NEWBURY OH
44065-9100
US

IV. Provider business mailing address

15849 ARBOR TRL
NEWBURY OH
44065-9100
US

V. Phone/Fax

Practice location:
  • Phone: 440-564-7773
  • Fax:
Mailing address:
  • Phone: 440-564-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number860081
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: