Basic Information
Provider Information
NPI: 1780725648
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MERCER
FirstName: KAREN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SAMRANY
OtherFirstName: KAREN
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PA-C
OtherLastNameType: 1
Mailing Information
Address1: 4 WOODCREST DRIVE
Address2:  
City: WHEELING
State: WV
PostalCode: 26003
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: WHEELING HOSPITAL INC
Address2: 1 MEDICAL PARK
City: WHEELING
State: WV
PostalCode: 26003
CountryCode: US
TelephoneNumber: 3042433124
FaxNumber: 3042436343
Other Information
ProviderEnumerationDate: 02/12/2007
LastUpdateDate: 03/17/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X01142WVY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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