Provider Demographics
NPI:1578594065
Name:MERCADO, AXEL L (PA C)
Entity Type:Individual
Prefix:
First Name:AXEL
Middle Name:L
Last Name:MERCADO
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LANGDON POINTE DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529
Mailing Address - Country:US
Mailing Address - Phone:305-278-8304
Mailing Address - Fax:252-237-5034
Practice Address - Street 1:2130 FOREST HILLS RD W STE B
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3681
Practice Address - Country:US
Practice Address - Phone:252-237-2700
Practice Address - Fax:252-237-5034
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00129654OtherRAILROAD MEDICARE
FL291219800Medicaid
P00129654OtherRAILROAD MEDICARE