Provider Demographics
NPI:1194758557
Name:MERENA, STEPHEN JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:MERENA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 TILLEY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4440
Mailing Address - Country:US
Mailing Address - Phone:802-847-2663
Mailing Address - Fax:802-847-3828
Practice Address - Street 1:192 TILLEY DR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4440
Practice Address - Country:US
Practice Address - Phone:802-847-2663
Practice Address - Fax:802-847-3828
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT056-0000174213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2096Medicaid
VT48378OtherBC/BS
VTU77924Medicare UPIN
VTVN2096Medicare ID - Type UnspecifiedINDIVIDUAL