Healthcare Provider Details

I. General information

NPI: 1477645133
Provider Name (Legal Business Name): ROHINTON K. MERCHANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RON MERCHANT MD

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 PACIFIC AVE 1 SOUTH
EVERETT WA
98201-4147
US

IV. Provider business mailing address

909 N BROADWAY PBO
EVERETT WA
98201-1409
US

V. Phone/Fax

Practice location:
  • Phone: 425-258-7390
  • Fax: 425-258-7379
Mailing address:
  • Phone: 425-258-7357
  • Fax: 425-258-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD00020956
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: