MEDICARE: JORGE SEBASTIAN MERINO HERRERA 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	207Q00000X	Family Medicine Physician	311669	NY
2	207Q00000X	Family Medicine Physician	2023-02864	NC

General Provider Information

NPI Number	:	1306332739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE SEBASTIAN MERINO HERRERA MD

Provider Business Mailing Address
First Line	:	1409 YANCEYVILLE ST STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6961
Country	:	US
Telephone Number	:	336-790-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 YANCEYVILLE ST STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6961
Country	:	US
Telephone Number	:	336-790-5400
Fax Number	:

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	09/27/2023

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