Provider Demographics
NPI:1790929172
Name:MERCADO MEDINA, MARGARITA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:
Last Name:MERCADO MEDINA
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 1:9212 18TH AVE SW UNIT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2723
Mailing Address - Country:US
Mailing Address - Phone:718-496-3126
Mailing Address - Fax:
Practice Address - Street 1:9212 18TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2723
Practice Address - Country:US
Practice Address - Phone:718-496-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2023-11-06
Deactivation Date:2022-06-06
Deactivation Code:
Reactivation Date:2022-07-27
Provider Licenses
StateLicense IDTaxonomies
NY252334207V00000X
WAMD61169253207V00000X, 208M00000X
CODR.0060465207V00000X, 208M00000X
WAMD60278741207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist