Provider Demographics
NPI:1023277183
Name:HENRY JOHN MEROLA, M.D., PC
Entity type:Organization
Organization Name:HENRY JOHN MEROLA, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MEROLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-894-8200
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59659207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty