Provider Demographics
NPI:1043436553
Name:RICHARD A. MERCURIO MD, INC
Entity Type:Organization
Organization Name:RICHARD A. MERCURIO MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MERCURIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-543-1735
Mailing Address - Street 1:198 WESTGATE DRIVE
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-8904
Mailing Address - Country:US
Mailing Address - Phone:724-543-1735
Mailing Address - Fax:
Practice Address - Street 1:198 WESTGATE DRIVE
Practice Address - Street 2:SUITE 101A
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-8904
Practice Address - Country:US
Practice Address - Phone:724-543-1735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031126E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007822999 0002Medicaid
PA0000066778Medicare PIN