Provider Demographics
NPI:1174537591
Name:MERCURI, ANTHONY THOMAS JR (DPM)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:THOMAS
Last Name:MERCURI
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-0186
Mailing Address - Country:US
Mailing Address - Phone:570-344-8686
Mailing Address - Fax:570-344-2841
Practice Address - Street 1:1416 MONROE AVE
Practice Address - Street 2:SUITE # 205
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18509-2477
Practice Address - Country:US
Practice Address - Phone:570-344-8686
Practice Address - Fax:570-344-2841
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001586L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA801213OtherFIRST PRIORITY HEALTH
0828220001OtherRRMC DUR MED EQUIP
PA1539221Medicaid
PAME129815Medicare ID - Type Unspecified
PA801213OtherFIRST PRIORITY HEALTH