Provider Demographics
NPI:1467640987
Name:MERCEDES MONTEALEGRE MD PA
Entity Type:Organization
Organization Name:MERCEDES MONTEALEGRE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:MONTEALEGRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-855-5455
Mailing Address - Street 1:12171 W LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1732
Mailing Address - Country:US
Mailing Address - Phone:813-855-5455
Mailing Address - Fax:813-855-9258
Practice Address - Street 1:12171 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1732
Practice Address - Country:US
Practice Address - Phone:813-855-5455
Practice Address - Fax:813-855-9258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL189854OtherAMERIGROUP
FL10324701OtherCITRUS
FL267380100Medicaid
FL291054OtherAVMED
FL81239OtherBLUE CROSS
FL291054OtherAVMED
FLH96518Medicare UPIN