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General NPI Number Information
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NPI Number | 1447647474
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Entity Type | Individual
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Provider Name | NICOLAS MERRITT DAT, PA-C, ATC
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Gender | Male
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Dates
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Enumeration Date | 04/16/2015
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 3020 14TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20009-6865
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Country | US
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Telephone | 202-469-4699
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Fax |
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Provider Business Mailing Address
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Address Line | 190 JACKSON ST
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City | NEWTON CENTER
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State | MA
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Zip | 02459-2540
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Country | US
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Telephone | 302-423-2499
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36002356A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | DC
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