Basic Information
| Provider Information | |||||||||
| NPI: | 1710954219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERRILL | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD, MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIA | ||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037561000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036505922 | ||||||||
| FaxNumber: | 6036508980 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIA | ||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037561000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036505922 | ||||||||
| FaxNumber: | 6036508980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 08/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 14661 | NH | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0748467 | 05 | IA | MEDICAID | 1017029 | 05 | VT | MEDICAID | 8255556 | 05 | WA | MEDICAID | 29542 | 01 | IA | WELLMARK BCBS | OTHER | 30209185 | 05 | NH | MEDICAID | 5531ME | 01 | WA | INDIVIDUAL BLUE SHIELD | OTHER | 050077267 | 01 | WA | RAIL ROAD MEDICARE | OTHER |