Provider Demographics
NPI:1871522425
Name:MERRITHEW, DANA A (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:A
Last Name:MERRITHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-0706
Mailing Address - Country:US
Mailing Address - Phone:314-989-0300
Mailing Address - Fax:603-238-2163
Practice Address - Street 1:103 BOULDER POINT DRIVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3168
Practice Address - Country:US
Practice Address - Phone:603-536-1881
Practice Address - Fax:603-238-2198
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0100949Y0NH01OtherANTHEM
NH42758OtherCIGNA
NH81110949Medicaid
NH81110949Medicaid
NH0100949Y0NH01OtherANTHEM
NH42758OtherCIGNA