Provider Demographics
NPI:1053595637
Name:MERCHANT, AZIZ M (MD)
Entity type:Individual
Prefix:DR
First Name:AZIZ
Middle Name:M
Last Name:MERCHANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:185 S ORANGE AVE
Mailing Address - Street 2:RUTGERS-NEW JERSEY MEDICAL SCHOOL, MSB G514
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2757
Mailing Address - Country:US
Mailing Address - Phone:973-972-0072
Mailing Address - Fax:
Practice Address - Street 1:185 S ORANGE AVE
Practice Address - Street 2:RUTGERS-NEW JERSEY MEDICAL SCHOOL, MSB G514
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2757
Practice Address - Country:US
Practice Address - Phone:973-972-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI095915208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01027261OtherHEALTH PLUS
MI7000784841OtherPRIORITY HEALTH
MI183023OtherGLHP
MI1053595637Medicaid
MI1053595637OtherCARESOURCE
MI0G36141021Medicare PIN