Provider Demographics
NPI:1558350355
Name:PICHARDO, MERCEDES (MD)
Entity Type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:
Last Name:PICHARDO
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:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0026
Mailing Address - Country:US
Mailing Address - Phone:787-834-4767
Mailing Address - Fax:787-834-4767
Practice Address - Street 1:URB EL BOSQUE
Practice Address - Street 2:CALLE FLAMBOYAN D3
Practice Address - City:LAS MARIAS
Practice Address - State:PR
Practice Address - Zip Code:00670
Practice Address - Country:US
Practice Address - Phone:787-827-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDM113019OtherASSMCA
PRBP441371BOtherDEA
PRBP441371BOtherDEA
PRDM113019OtherASSMCA