Provider Demographics
NPI:1821007626
Name:MERCER, MICHELE L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:MERCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:L
Other - Last Name:CANAMUCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:374 HUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-9444
Mailing Address - Country:US
Mailing Address - Phone:828-245-0095
Mailing Address - Fax:828-248-1378
Practice Address - Street 1:374 HUDLOW RD
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-9444
Practice Address - Country:US
Practice Address - Phone:828-245-0095
Practice Address - Fax:828-248-1378
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-00228207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134FGMedicaid
C6217OtherMEDCOST
NC134FGOtherBCBS
0103884OtherUNITED
C6217OtherMEDCOST
0103884OtherUNITED