Provider Demographics
NPI:1285603613
Name:MEROLA, WENDY M (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:MEROLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 CYPRESS CREEK RD BLDG 1 SUITE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-615-9191
Mailing Address - Fax:512-615-9199
Practice Address - Street 1:901 CYPRESS CREEK RD BLDG 1 SUITE 100
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-615-9191
Practice Address - Fax:512-615-9199
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133379101Medicaid
TXE83478Medicare UPIN
TX133379101Medicaid