Provider Demographics
NPI:1477621258
Name:MEZCUA, SERGIO L (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:L
Last Name:MEZCUA
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 1:6121 COLERAIN AVE STE 2500
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6417
Mailing Address - Country:US
Mailing Address - Phone:513-354-2466
Mailing Address - Fax:513-906-5477
Practice Address - Street 1:6121 COLERAIN AVE STE 2500
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6417
Practice Address - Country:US
Practice Address - Phone:513-354-2466
Practice Address - Fax:513-906-5477
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0116869Medicaid
OH0116869Medicaid