Provider Demographics
NPI:1114102829
Name:A T MERCURI DPM
Entity Type:Organization
Organization Name:A T MERCURI DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MERCURI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-344-8686
Mailing Address - Street 1:1416 MONROE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2477
Mailing Address - Country:US
Mailing Address - Phone:570-344-8686
Mailing Address - Fax:570-344-2841
Practice Address - Street 1:1416 MONROE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18509-2477
Practice Address - Country:US
Practice Address - Phone:570-344-8686
Practice Address - Fax:570-344-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001586L332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA801213OtherFIRST PRIORITY HEALTH
PA0015392210001Medicaid
PA0015392210001Medicaid
PA0828220001Medicare NSC
PAME129815Medicare PIN