Provider Demographics
NPI:1033147889
Name:MERCADO DE GORGOLAS, MARCOS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:
Last Name:MERCADO DE GORGOLAS
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:E1 CALLE MIRAMONTE
Mailing Address - Street 2:GARDEN COURT
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2032
Mailing Address - Country:US
Mailing Address - Phone:787-621-3740
Mailing Address - Fax:787-621-3251
Practice Address - Street 1:MANATI MEDICAL CENTER DR OTERO LOPEZ
Practice Address - Street 2:SUITE 201
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-621-3737
Practice Address - Fax:787-621-3251
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR14613207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH93283Medicare UPIN
PR21673Medicare ID - Type Unspecified