Provider Demographics
NPI:1487751418
Name:MERCER, ZONDA JEANNE (MD)
Entity type:Individual
Prefix:
First Name:ZONDA
Middle Name:JEANNE
Last Name:MERCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 COGSWELL AVE
Mailing Address - Street 2:APT 21
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2045
Mailing Address - Country:US
Mailing Address - Phone:617-547-3947
Mailing Address - Fax:
Practice Address - Street 1:1234 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1703
Practice Address - Country:US
Practice Address - Phone:617-547-3947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31932101YP2500X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB11453OtherBCBS
MAA31480Medicare ID - Type UnspecifiedWORCESTER, MA
A33595Medicare UPIN
MAA29086Medicare ID - Type Unspecified