Healthcare Provider Details

I. General information

NPI: 1235162967
Provider Name (Legal Business Name): ADELAIDA MERKER D.O., P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 06/29/2010
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: 215-677-6225
Mailing address:
  • Phone: 215-677-6616
  • Fax: 215-677-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS040658L
License Number StatePA

VIII. Authorized Official

Name: ADELAIDA MERKER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 215-677-6616