Provider Demographics
NPI:1609860352
Name:MERCURO, ELISA J (DO)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:J
Last Name:MERCURO
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Gender:F
Credentials:DO
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Mailing Address - Street 1:6 TSIENNETO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1584
Mailing Address - Country:US
Mailing Address - Phone:603-537-1300
Mailing Address - Fax:603-537-1355
Practice Address - Street 1:6 TSIENNETO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1584
Practice Address - Country:US
Practice Address - Phone:603-537-1300
Practice Address - Fax:603-537-1355
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NH12395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30223121Medicaid
NHI21371Medicare UPIN
NH30223121Medicaid