Provider Demographics
NPI:1336473529
Name:MICHAEL MERCATORIS, PH.D. & ASSOC. P.C.
Entity Type:Organization
Organization Name:MICHAEL MERCATORIS, PH.D. & ASSOC. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCATORIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-336-6308
Mailing Address - Street 1:462 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-4403
Mailing Address - Country:US
Mailing Address - Phone:814-336-6308
Mailing Address - Fax:814-337-6067
Practice Address - Street 1:462 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-4403
Practice Address - Country:US
Practice Address - Phone:814-336-6308
Practice Address - Fax:814-337-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005824B363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty