1578628715 NPI number — GLORIA V MERCADO M.D.

Table of content: GLORIA V MERCADO M.D. (NPI 1578628715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578628715 NPI number — GLORIA V MERCADO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERCADO
Provider First Name:
GLORIA
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1578628715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
387 QUARRY ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FALL RIVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02723-1025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-679-8111
Provider Business Mailing Address Fax Number:
508-674-5028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
387 QUARRY ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02723-1025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-679-8111
Provider Business Practice Location Address Fax Number:
508-674-5028
Provider Enumeration Date:
12/27/2006

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: 208D00000X , with the licence number:  51934 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3003604 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 412269 . This is a "BC BS OF RI (BLUECHIP)" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 44289 . This is a "CHILDREN'S MEDICAL SP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0039507 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0103124 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 210126 . This is a "BC BS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 961245-01 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J05037 . This is a "BC BS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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