Provider Demographics
NPI:1306332739
Name:MERINO HERRERA, JORGE SEBASTIAN (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:SEBASTIAN
Last Name:MERINO HERRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 YANCEYVILLE ST STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6961
Mailing Address - Country:US
Mailing Address - Phone:336-790-5400
Mailing Address - Fax:
Practice Address - Street 1:1409 YANCEYVILLE ST STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6961
Practice Address - Country:US
Practice Address - Phone:336-790-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311669207Q00000X
NC2023-02864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine