=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215121397
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIN SUZANNE MERGLER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2007
-----------------------------------------------------
Last Update Date | 06/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 CHILDRENS PLZ
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45404-1898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-641-3433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7110 MONTGOMERY CO LINE RD
-----------------------------------------------------
City | BROOKVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45309-9639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-884-7198
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 35.095483
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------