Provider Demographics
NPI:1891218228
Name:BABU, MERIN SARA (PA-C)
Entity type:Individual
Prefix:
First Name:MERIN
Middle Name:SARA
Last Name:BABU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MERIN
Other - Middle Name:SARA
Other - Last Name:PHILIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1948 E HEBRON PKWY
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1514
Mailing Address - Country:US
Mailing Address - Phone:972-939-4646
Mailing Address - Fax:972-939-6161
Practice Address - Street 1:809 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2507
Practice Address - Country:US
Practice Address - Phone:817-277-7133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11347363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX380946901Medicaid