Provider Demographics
NPI:1689628026
Name:LOSSADA, MERY J (MD)
Entity Type:Individual
Prefix:
First Name:MERY
Middle Name:J
Last Name:LOSSADA
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:PO BOX 4860
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-4860
Mailing Address - Country:US
Mailing Address - Phone:352-873-7400
Mailing Address - Fax:352-873-7435
Practice Address - Street 1:3231 SW 34TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-8489
Practice Address - Country:US
Practice Address - Phone:352-873-7400
Practice Address - Fax:352-873-7435
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME811602084H0002X, 2084N0400X, 2084P0800X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No2084H0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyHospice and Palliative Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01097YOtherMEDICARE
FL01097OtherBCBS
FL201890745OtherTAX ID
FL272842700Medicaid
FL272842700Medicaid
FL272842700Medicaid