1033147889 NPI number — DR. MARCOS MERCADO DE GORGOLAS M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033147889 NPI number — DR. MARCOS MERCADO DE GORGOLAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERCADO DE GORGOLAS
Provider First Name:
MARCOS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033147889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
E1 CALLE MIRAMONTE
Provider Second Line Business Mailing Address:
GARDEN COURT
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966-2032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-621-3740
Provider Business Mailing Address Fax Number:
787-621-3251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MANATI MEDICAL CENTER DR OTERO LOPEZ
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-621-3737
Provider Business Practice Location Address Fax Number:
787-621-3251
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  14613 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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