Provider Demographics
NPI:1578664496
Name:MERCADO, HIRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HIRAM
Middle Name:
Last Name:MERCADO
Suffix:
Gender:M
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 11981
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1981
Mailing Address - Country:US
Mailing Address - Phone:787-781-1450
Mailing Address - Fax:787-273-9177
Practice Address - Street 1:1785 CARR 21
Practice Address - Street 2:LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3399
Practice Address - Country:US
Practice Address - Phone:787-781-1450
Practice Address - Fax:787-273-9177
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2682207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0094464Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRE08228Medicare UPIN