Provider Demographics
NPI:1639346869
Name:OLIVO MERCEDES, YOHANNA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:YOHANNA
Middle Name:MARIA
Last Name:OLIVO MERCEDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2676 GRAND CONCOURSE
Mailing Address - Street 2:A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4914
Mailing Address - Country:US
Mailing Address - Phone:718-708-4040
Mailing Address - Fax:718-708-6040
Practice Address - Street 1:2676 GRAND CONCOURSE
Practice Address - Street 2:A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4914
Practice Address - Country:US
Practice Address - Phone:718-708-4040
Practice Address - Fax:718-708-6040
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME108333207R00000X
NJ25MA09215300208M00000X
NY266860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003250800Medicaid
NJ0333794Medicaid
NJ268781YH9B.OtherMEDICARE PTAN
NYA400097542OtherMEDICARE PTAN
NY03637116Medicaid
NY03637116Medicaid