Healthcare Provider Details

I. General information

NPI: 1104821727
Provider Name (Legal Business Name): ADELAIDA MERKER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 RED LION RD UNIT 7
PHILADELPHIA PA
19115-1475
US

IV. Provider business mailing address

842 RED LION RD UNIT 7
PHILADELPHIA PA
19115-1475
US

V. Phone/Fax

Practice location:
  • Phone: 215-677-6616
  • Fax:
Mailing address:
  • Phone: 215-677-6616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS010658L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: