MEDICARE: MANUEL J MERINO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	37028	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205836582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUEL J MERINO MD

Provider Business Mailing Address
First Line	:	41 MALL RD
Second Line	:	LAHEY CLINIC
City	:	BURLINGTON
State	:	MA
Zip	:	01805-0001
Country	:	US
Telephone Number	:	781-744-7284
Fax Number	:	781-744-5411

Provider Business Practice Location Address
First Line	:	41 MALL RD
Second Line	:	LAHEY CLINIC
City	:	BURLINGTON
State	:	MA
Zip	:	01805-0001
Country	:	US
Telephone Number	:	781-744-7284
Fax Number	:	781-744-5411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	03/04/2011

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