Provider Demographics
NPI:1699022574
Name:MERCURIO, RENARD (L AC)
Entity Type:Individual
Prefix:
First Name:RENARD
Middle Name:
Last Name:MERCURIO
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 HARDING PL
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2896
Mailing Address - Country:US
Mailing Address - Phone:704-706-7824
Mailing Address - Fax:
Practice Address - Street 1:1112 HARDING PL
Practice Address - Street 2:SUITE # 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2896
Practice Address - Country:US
Practice Address - Phone:704-706-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC554171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist