Provider Demographics
NPI:1437127859
Name:MERCURI, JAMES THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMAS
Last Name:MERCURI
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 1:141 VERSTREET DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-4105
Mailing Address - Country:US
Mailing Address - Phone:585-730-8240
Mailing Address - Fax:585-730-8311
Practice Address - Street 1:141 VERSTREET DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-4105
Practice Address - Country:US
Practice Address - Phone:585-730-8240
Practice Address - Fax:585-730-8311
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188287207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01347548Medicaid
NY103200OtherPREFERRED CARE PROVIDER #
NY10754BMedicare PIN
NY01347548Medicaid