Basic Information
| Provider Information | |||||||||
| NPI: | 1700375839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERICA | ||||||||
| FirstName: | JILLIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PHYSICIANS OFFICE BUILDING 170 MANNING DRIVE CB 7594 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | PHYSICIANS OFFICE BUILDING 170 MANNING DRIVE CB 7594 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199666440 | ||||||||
| FaxNumber: | 9199663049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2018 | ||||||||
| LastUpdateDate: | 06/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 238914 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 2021-00475 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.