Provider Demographics
NPI:1538768239
Name:MD1, INC
Entity type:Organization
Organization Name:MD1, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:844-631-3627
Mailing Address - Street 1:55 LANE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1015
Mailing Address - Country:US
Mailing Address - Phone:844-631-3627
Mailing Address - Fax:
Practice Address - Street 1:55 LANE RD STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1015
Practice Address - Country:US
Practice Address - Phone:844-631-3627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty