Provider Demographics
NPI:1033220132
Name:MERCANDO, NOREEN A (DO)
Entity Type:Individual
Prefix:DR
First Name:NOREEN
Middle Name:A
Last Name:MERCANDO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 TOWNE LAKE PKWY STE 410
Mailing Address - Street 2:TOWNE LAKE PRIMARY CARE
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1604
Mailing Address - Country:US
Mailing Address - Phone:678-445-0819
Mailing Address - Fax:678-445-0927
Practice Address - Street 1:900 TOWNE LAKE PKWY STE 410
Practice Address - Street 2:TOWNE LAKE PRIMARY CARE
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1604
Practice Address - Country:US
Practice Address - Phone:678-445-0819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070489207Q00000X
NJ25MB06638400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
036743B1MMedicare ID - Type Unspecified
H12810Medicare UPIN