Basic Information
| Provider Information | |||||||||
| NPI: | 1083612709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERWIN | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5130 MANCHESTER DR | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437019090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404559374 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 620B MORRISON RD | ||||||||
| Address2: | |||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432305327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6149444770 | ||||||||
| FaxNumber: | 6149444771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0203X | 35052690M | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 311294756005 | 01 | OH | MEDICAL MUTUAL | OTHER | 000000119478 | 01 | OH | ANTHEM | OTHER | 029415600 | 01 | OH | BLACK LUNG | OTHER | 0703359 | 05 | OH | MEDICAID | 360002962 | 01 | OH | RAILROAD MADICARE | OTHER |