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General NPI Number Information
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NPI Number | 1710906136
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Entity Type | Individual
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Provider Name | LOUIS THAYER MERRIAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 11/11/2014
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Provider Practice Location Address
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Address Line | 130 FISHER RD SUITE 3-1
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City | BERLIN
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State | VT
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Zip | 05602-9516
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Country | US
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Telephone | 802-225-7039
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Fax |
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Provider Business Mailing Address
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Address Line | 130 FISHER RD STE 3-1 BERLIN GENERAL SURGERY
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City | BERLIN
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State | VT
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Zip | 05602-9000
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Country | US
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Telephone | 802-225-7039
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 212039
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 042.0012371
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License Number State | VT
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