Provider Demographics
NPI:1386924991
Name:MERBOTH, ELEANOR DORIS (CRNP)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:DORIS
Last Name:MERBOTH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:6100 DOBBIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:443-492-4000
Mailing Address - Fax:
Practice Address - Street 1:6100 DOBBIN RD.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:443-492-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR173589363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD051086600Medicaid