Provider Demographics
NPI:1477623494
Name:MERCURIO, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:MERCURIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:198 WESTGATE DRIVE
Mailing Address - Street 2:SUITE 101 A
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-8904
Mailing Address - Country:US
Mailing Address - Phone:724-543-1735
Mailing Address - Fax:724-548-5899
Practice Address - Street 1:198 WESTGATE DRIVE
Practice Address - Street 2:SUITE 101 A
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-8904
Practice Address - Country:US
Practice Address - Phone:724-543-1735
Practice Address - Fax:724-548-5899
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2015-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD031126E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000953845 0009Medicaid
PA000953845 0009Medicaid