Provider Demographics
NPI:1922411719
Name:MERCADO, ERICKSON SORIANO
Entity Type:Individual
Prefix:MR
First Name:ERICKSON
Middle Name:SORIANO
Last Name:MERCADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 PARKLAWN TER APT 301
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-5236
Mailing Address - Country:US
Mailing Address - Phone:410-212-6316
Mailing Address - Fax:
Practice Address - Street 1:5116 PARKLAWN TER APT 301
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-5236
Practice Address - Country:US
Practice Address - Phone:410-212-6316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist