Provider Demographics
NPI:1366506453
Name:MERLIN, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MERLIN
Suffix:
Gender:F
Credentials:
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 55310
Mailing Address - Street 2:9 SOUTH MONTEFIORE HOSPITAL PROD E
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:9 SOUTH MONTEFIORE HOSPITAL PROD E
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-1900
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30915207RI0200X
NY256378207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051118206OtherBCBS
AL051118203OtherBCBS
AL051118209OtherBCBS
AL129711Medicaid
AL051119346OtherBCBS
AL129715Medicaid
AL129712Medicaid
AL129713Medicaid
AL129714Medicaid
AL129710Medicaid
AL129716Medicaid
AL051118208OtherBCBS
AL051118204OtherBCBS
AL051118205OtherBCBS
ALZ19099OtherVIVA
AL129709Medicaid
AL051118207OtherBCBS
MS06955818Medicaid
AL129712Medicaid
AL129715Medicaid