Provider Demographics
NPI:1073610515
Name:MERCADO, ROBERTO A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
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 1:1425 S OSPREY AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2900
Mailing Address - Country:US
Mailing Address - Phone:941-366-9060
Mailing Address - Fax:941-552-1588
Practice Address - Street 1:1425 S OSPREY AVE
Practice Address - Street 2:STE 1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2900
Practice Address - Country:US
Practice Address - Phone:941-366-9060
Practice Address - Fax:941-552-1588
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079981207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259689000Medicaid
FL35640OtherBCBS FL
FL35640ZMedicare PIN
FL35640OtherBCBS FL