Basic Information
| Provider Information | |||||||||
| NPI: | 1609962547 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKENZIE | ||||||||
| FirstName: | MERRILL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 EAST MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177653400 | ||||||||
| FaxNumber: | 7177653408 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 EAST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177654000 | ||||||||
| FaxNumber: | 7177653447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 01/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD035052E | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 930088503 | 01 | MEDICARE RAILROAD | OTHER | 1364074 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 2056466000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 20015310 | 05 | PA | MEDICAID |