Healthcare Provider Details

I. General information

NPI: 1134469935
Provider Name (Legal Business Name): ANTHONY MERLOCCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N DUNLAP ST
MEMPHIS TN
38105-4625
US

IV. Provider business mailing address

51 N DUNLAP ST
MEMPHIS TN
38105-4625
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-6819
  • Fax:
Mailing address:
  • Phone: 901-287-6819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD043908
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number55995
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: