Provider Demographics
NPI:1578628715
Name:MERCADO, GLORIA V (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:V
Last Name:MERCADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:387 QUARRY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1025
Mailing Address - Country:US
Mailing Address - Phone:508-679-8111
Mailing Address - Fax:508-674-5028
Practice Address - Street 1:387 QUARRY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1025
Practice Address - Country:US
Practice Address - Phone:508-679-8111
Practice Address - Fax:508-674-5028
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2013-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA51934208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3003604Medicaid
RI412269OtherBC BS OF RI (BLUECHIP)
MA44289OtherCHILDREN'S MEDICAL SP
MA0039507OtherNEIGHBORHOOD HEALTH PLAN
MA0103124OtherUNITEDHEALTHCARE
RI210126OtherBC BS OF RI
MA961245-01OtherNETWORK HEALTH
MAJ05037OtherBC BS OF MA
MA0039507OtherNEIGHBORHOOD HEALTH PLAN
RI210126OtherBC BS OF RI