Provider Demographics
NPI:1386098093
Name:MERRILL, JOHANNAH KATHRYN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHANNAH
Middle Name:KATHRYN
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EXECUTIVE DR UNIT 414
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-0032
Mailing Address - Country:US
Mailing Address - Phone:434-981-9742
Mailing Address - Fax:
Practice Address - Street 1:1 GENERAL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2997
Practice Address - Country:US
Practice Address - Phone:434-981-9742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-00453207P00000X
390200000X
MA281944207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program