Healthcare Provider Details

I. General information

NPI: 1871694091
Provider Name (Legal Business Name): WYNDELL HUNT MERRITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7660 E PARHAM RD SUITE 200
HENRICO VA
23294-4378
US

IV. Provider business mailing address

7660 E PARHAM RD SUITE 200
HENRICO VA
23294-4378
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-2112
  • Fax: 804-282-7133
Mailing address:
  • Phone: 804-282-2112
  • Fax: 804-282-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number15121
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number0101026492
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: