1255478160 NPI number — DR. FRANK MERCER III DPM

Table of content: DR. FRANK MERCER III DPM (NPI 1255478160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255478160 NPI number — DR. FRANK MERCER III DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERCER
Provider First Name:
FRANK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DPM
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:
1255478160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
533 RODNEY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23464-2227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-963-8868
Provider Business Mailing Address Fax Number:
757-963-8867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 TIDEWATER DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23504-2840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-963-8868
Provider Business Practice Location Address Fax Number:
757-963-8867
Provider Enumeration Date:
01/31/2007

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: 213EP1101X , with the licence number:  0103000848 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009300066 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 095891 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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