Healthcare Provider Details

I. General information

NPI: 1346745189
Provider Name (Legal Business Name): ELLIOT MERIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N QUINCY ST STE 601
ARLINGTON VA
22203-1729
US

IV. Provider business mailing address

1438 S GRAND BLVD
SAINT LOUIS MO
63104-1027
US

V. Phone/Fax

Practice location:
  • Phone: 703-812-4642
  • Fax:
Mailing address:
  • Phone: 314-577-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101275187
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: