Provider Demographics
NPI:1245426253
Name:MERCED, MARIANGELA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIANGELA
Middle Name:
Last Name:MERCED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01129-1930
Mailing Address - Country:US
Mailing Address - Phone:413-222-5124
Mailing Address - Fax:
Practice Address - Street 1:100 WASON AVE STE 120
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1179
Practice Address - Country:US
Practice Address - Phone:413-241-2100
Practice Address - Fax:413-735-1986
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA2381363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA322704Medicare UPIN