Provider Demographics
NPI:1003966896
Name:MERCADO, GEORGE A (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:MERCADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-1411
Mailing Address - Country:US
Mailing Address - Phone:606-564-4016
Mailing Address - Fax:606-564-8288
Practice Address - Street 1:611 FOREST AVE
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-1411
Practice Address - Country:US
Practice Address - Phone:606-564-4016
Practice Address - Fax:606-564-8288
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY429822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30608012Medicaid
KY7100127090Medicaid
KY0390624Medicare PIN
KY0390523Medicare PIN
KY0509223Medicare PIN
KY0509320Medicare PIN