Basic Information
Provider Information
NPI: 1023126760
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MERRYMAN
FirstName: GINNY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8110 MAPLE LAWN BLVD STE 235
Address2:  
City: FULTON
State: MD
PostalCode: 207592694
CountryCode: US
TelephoneNumber: 3013408339
FaxNumber: 3013409027
Practice Location
Address1: 6569 N CHARLES ST
Address2: SUITE 501
City: BALTIMORE
State: MD
PostalCode: 212046831
CountryCode: US
TelephoneNumber: 4109388960
FaxNumber: 4105839770
Other Information
ProviderEnumerationDate: 08/25/2006
LastUpdateDate: 03/31/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/31/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XD0039172MDY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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