Provider Demographics
NPI:1992760912
Name:MERPORT, IRINA (MD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:MERPORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:VRONTISIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:STE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-973-9650
Practice Address - Fax:508-973-9655
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIIM35917Medicaid
MA110003186AMedicaid
RIIM35917Medicaid
RIIM35917OtherMEDICAID
MA114432OtherHEALTH PARTNERS
MAB10515608OtherCIGNA
MAJ23369OtherBLUE SHIELD
MA690027OtherHARVARD PILGRIM
MAA31105Medicare ID - Type UnspecifiedMEDICARE
MA0022480OtherNEIGHBORHOOD HEALTHPLAN
MA110219109OtherRAILROAD MEDICARE
MA158516OtherTUFTS HEALTH PLAN
RI408529OtherBLUE CHIP
MAH16596Medicare UPIN
RI0000029262OtherBLUE SHIELD
MA2575711OtherAETNA
MA0138339Medicaid