Provider Demographics
NPI:1619942240
Name:PINEIRO-MERCADO, EDGARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:
Last Name:PINEIRO-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 1:8118 CALLE CONCORDIA
Mailing Address - Street 2:EDIFICIO GALERIA PROFESIONAL SUITE 104
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1562
Mailing Address - Country:US
Mailing Address - Phone:787-259-5465
Mailing Address - Fax:787-259-4018
Practice Address - Street 1:8118 CALLE CONCORDIA
Practice Address - Street 2:EDIFICIO GALERIA PROFESIONAL SUITE 104
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1562
Practice Address - Country:US
Practice Address - Phone:787-259-5465
Practice Address - Fax:787-259-4018
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7243207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE91779Medicare UPIN
PR0028400Medicare ID - Type UnspecifiedPROVIDER