Provider Demographics
NPI:1497334213
Name:MERRILL, ANDREW JOSEPH
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOSEPH
Last Name:MERRILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 EDWARDS RD FL 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1678
Mailing Address - Country:US
Mailing Address - Phone:513-981-4646
Mailing Address - Fax:513-979-2830
Practice Address - Street 1:4101 EDWARDS RD FL 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1678
Practice Address - Country:US
Practice Address - Phone:513-981-4646
Practice Address - Fax:513-979-2830
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH34.017003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program