Provider Demographics
NPI:1427359157
Name:MERCADO-SEDA, ROGELIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:
Last Name:MERCADO-SEDA
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:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0343
Mailing Address - Country:US
Mailing Address - Phone:787-377-2333
Mailing Address - Fax:
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:STE 410
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1504
Practice Address - Country:US
Practice Address - Phone:787-652-3030
Practice Address - Fax:787-652-4848
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19054207N00000X
PR28646-R207N00000X
PR28935-R207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR19054OtherJUNTA DE LICENCIAMIENTO Y DISCIPLINA MEDICA
PR28935-ROtherJUNTA DE LICENCIAMIENTO Y DISCIPLINA MEDICA
PR28646-ROtherJUNTA DE LICENCIAMIENTO Y DISCIPLINA MEDICA