Provider Demographics
NPI:1457327983
Name:YIA, GRACE MERCADO (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MERCADO
Last Name:YIA
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 1:723 N BEERS ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1517
Mailing Address - Country:US
Mailing Address - Phone:732-264-3344
Mailing Address - Fax:732-264-1699
Practice Address - Street 1:723 N BEERS ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1517
Practice Address - Country:US
Practice Address - Phone:732-264-3344
Practice Address - Fax:732-264-1699
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA067810208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics