Provider Demographics
NPI:1497767255
Name:MERCADO, MARLENE (MD)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:MERCADO
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 1:421 SE OSCEOLA ST
Mailing Address - Street 2:P.O. BOX 868
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2505
Mailing Address - Country:US
Mailing Address - Phone:772-286-0338
Mailing Address - Fax:772-297-1139
Practice Address - Street 1:421 SE OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2505
Practice Address - Country:US
Practice Address - Phone:772-286-0338
Practice Address - Fax:772-287-1139
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78422207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47069OtherBCBS OF FLORIDA
FLG97455Medicare UPIN
FL47069OtherBCBS OF FLORIDA