Provider Demographics
NPI:1447647474
Name:MERRITT, NICOLAS (DAT, PA-C, ATC)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:MERRITT
Suffix:
Gender:M
Credentials:DAT, PA-C, ATC
Other - Prefix:
Other - First Name:NICO
Other - Middle Name:
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DAT, PA-C, ATC
Mailing Address - Street 1:190 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2540
Mailing Address - Country:US
Mailing Address - Phone:302-423-2499
Mailing Address - Fax:
Practice Address - Street 1:3020 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6865
Practice Address - Country:US
Practice Address - Phone:202-469-4699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002356A2255A2300X
DC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer