Individual
PERSILA V. MERTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
115 E MAIN ST, EPHRATA, PA 17522-2710
(717) 733-3600
(717) 721-3038
Mailing address
115 E MAIN ST, EPHRATA, PA 17522-2710
(717) 733-3600
(717) 721-3038
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD043167E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093980
MEDICARE PROVIDER #
PA
01
—
1093934655
GROUP NPI
PA
01
—
110758
MEDICARE PTAN
—
01
—
5984190001
DMEPOS PTAN
PA
Enumeration date
04/04/2006
Last updated
07/07/2014
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