Provider Demographics
NPI:1801820105
Name:MERCER, ELIZABETH (PAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MERCER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3744 WESTVALE DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-9110
Mailing Address - Country:US
Mailing Address - Phone:607-753-3705
Mailing Address - Fax:
Practice Address - Street 1:10 ARROWOOD DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1857
Practice Address - Country:US
Practice Address - Phone:607-753-3705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1019514363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01641996Medicaid
NYPA1829Medicare PIN