Provider Demographics
NPI:1477559706
Name:MERCADANTE, GINO (DO)
Entity Type:Individual
Prefix:
First Name:GINO
Middle Name:
Last Name:MERCADANTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-2772
Mailing Address - Country:US
Mailing Address - Phone:413-589-7176
Mailing Address - Fax:413-589-7710
Practice Address - Street 1:200 CENTER ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-2772
Practice Address - Country:US
Practice Address - Phone:413-589-7176
Practice Address - Fax:413-589-7710
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3059766Medicaid
MAE42429Medicare UPIN
MA3059766Medicaid