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General NPI Number Information
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NPI Number | 1003096017
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Entity Type | Organization
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Legal Business Name | DANIEL MARK MERSON
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 1250 FOREST AVE
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City | PORTLAND
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State | ME
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Zip | 04103-1889
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Country | US
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Telephone | 207-878-5042
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Fax | 207-878-5043
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Provider Business Mailing Address
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Address Line | 1250 FOREST AVE
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City | PORTLAND
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State | ME
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Zip | 04103-1889
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Country | US
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Telephone | 207-878-5042
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Fax | 207-878-5043
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL MARK MERSON
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Credential | D.O.
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Telephone | 207-878-5042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME1373
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License Number State | ME
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