Provider Demographics
NPI:1174692297
Name:MARY MERCADO MD PA
Entity type:Organization
Organization Name:MARY MERCADO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-935-8755
Mailing Address - Street 1:6807 EMMETT F LOWRY EXPY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-2546
Mailing Address - Country:US
Mailing Address - Phone:409-935-8755
Mailing Address - Fax:409-933-0171
Practice Address - Street 1:6807 EMMETT F LOWRY EXPY
Practice Address - Street 2:SUITE 304
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2546
Practice Address - Country:US
Practice Address - Phone:409-935-8755
Practice Address - Fax:409-933-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4350174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00943KMedicare PIN
ALG08045Medicare UPIN