Provider Demographics
NPI:1144297284
Name:COULTER, MERLIN K (MD)
Entity type:Individual
Prefix:DR
First Name:MERLIN
Middle Name:K
Last Name:COULTER
Suffix:
Gender:M
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:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-0760
Mailing Address - Country:US
Mailing Address - Phone:812-254-7310
Mailing Address - Fax:
Practice Address - Street 1:1805 S SR 57
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4326
Practice Address - Country:US
Practice Address - Phone:812-254-7845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027289A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100089260AMedicaid
INCA5604OtherMEDICARE RAILROAD GROUP
IN000000316884OtherANTHEM
IN080091371OtherMEDICARE RAILROAD
INCA5604OtherMEDICARE RAILROAD GROUP
IN080091371OtherMEDICARE RAILROAD