Provider Demographics
NPI:1104821727
Name:MERKER, ADELAIDA (DO)
Entity type:Individual
Prefix:
First Name:ADELAIDA
Middle Name:
Last Name:MERKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 RED LION RD
Mailing Address - Street 2:UNIT 7
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1475
Mailing Address - Country:US
Mailing Address - Phone:215-677-6616
Mailing Address - Fax:
Practice Address - Street 1:842 RED LION RD
Practice Address - Street 2:UNIT 7
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1475
Practice Address - Country:US
Practice Address - Phone:215-677-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010658L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA019009170002Medicaid
PA046978Medicare ID - Type Unspecified
PA019009170002Medicaid