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MERRITT JONATHAN BERN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3 RIVERSIDE CIR, CARILION CLINIC GASTROENTEROLGY RIVERSIDE 3, ROANOKE, VA 24016-4955
(540) 224-5170
(540) 985-9418
Mailing address
3 RIVERSIDE CIR, CARILION CLINIC GASTROENTEROLGY RIVERSIDE 3, ROANOKE, VA 24016-4955
(540) 224-5170
(540) 985-9418

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
0101040654
VA
207RG0100X
Gastroenterology Physician
Primary
01080690A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
006097839
VA
01
100009137
MC RAIL ROAD
01
260856
ANTHEM
01
VVA900A
MEDICARE PTAN
VA
Enumeration date
01/04/2006
Last updated
12/04/2018
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