Provider Demographics
NPI:1649277997
Name:MERRILL, RICHARD HOSMER (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HOSMER
Last Name:MERRILL
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 939
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-0939
Mailing Address - Country:US
Mailing Address - Phone:252-754-2900
Mailing Address - Fax:252-754-2999
Practice Address - Street 1:990 JOHNS HOPKINS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7224
Practice Address - Country:US
Practice Address - Phone:252-754-2900
Practice Address - Fax:252-754-2999
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2013-05-06
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
NC34056174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8958656Medicaid
NC0266VOtherBCBS PROV NUMBER
NC208811BMedicare PIN
NC0266VOtherBCBS PROV NUMBER