Provider Demographics
NPI:1902963986
Name:MEROLA, HENRY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JOHN
Last Name:MEROLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:32 SOUTH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3594
Mailing Address - Country:US
Mailing Address - Phone:781-894-8200
Mailing Address - Fax:781-894-8202
Practice Address - Street 1:32 SOUTH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3594
Practice Address - Country:US
Practice Address - Phone:781-894-8200
Practice Address - Fax:781-894-8202
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA59659207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1902963986OtherMEDICARE NPI
MA3145221Medicaid
MAJ07727OtherMEDICARE ID
MAJ07727OtherMEDICARE ID
MAA14213Medicare UPIN