1790898278 NPI number — ERLINDA PENALOSA MERCADO 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 1790898278 NPI number — ERLINDA PENALOSA MERCADO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERCADO
Provider First Name:
ERLINDA
Provider Middle Name:
PENALOSA
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:
1790898278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 CHAMBERS ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48723-9296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-673-3191
Provider Business Mailing Address Fax Number:
989-673-0064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 351
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06457-7023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-395-5042
Provider Business Practice Location Address Fax Number:
860-395-5058
Provider Enumeration Date:
08/17/2006

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: 2084P0800X , with the licence number:  EM031514 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 64604 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 83466 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P00027113 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104866882 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2606386671 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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