Provider Demographics
NPI:1871554535
Name:HANEBERG-MERLING, MARY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:HANEBERG-MERLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:MERLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1184 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2009
Mailing Address - Country:US
Mailing Address - Phone:937-382-1616
Mailing Address - Fax:937-382-7877
Practice Address - Street 1:1184 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2009
Practice Address - Country:US
Practice Address - Phone:937-382-7168
Practice Address - Fax:937-382-7877
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059350208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0799471Medicaid
OHME4257472Medicare PIN
OHE76641Medicare UPIN
OH0799471Medicaid
OH4257473Medicare PIN