Provider Demographics
NPI:1376515965
Name:CRESPO, MARIA MERCEDES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:MERCEDES
Last Name:CRESPO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5161
Mailing Address - Country:US
Mailing Address - Phone:215-662-3202
Mailing Address - Fax:215-349-8432
Practice Address - Street 1:3400 CIVIC CENTER BLVD FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5161
Practice Address - Country:US
Practice Address - Phone:215-662-3202
Practice Address - Fax:215-349-8432
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423318207RP1001X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100939992Medicaid
PAG32596Medicare UPIN
PA076822GAHMedicare ID - Type Unspecified