Provider Demographics
NPI:1962671313
Name:FADOJU, MERCY O (CRNP)
Entity Type:Individual
Prefix:
First Name:MERCY
Middle Name:O
Last Name:FADOJU
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 CHANTILLA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3703
Mailing Address - Country:US
Mailing Address - Phone:443-904-5129
Mailing Address - Fax:410-869-4603
Practice Address - Street 1:413 COMMONWEALTH AVE STE 7
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-3044
Practice Address - Country:US
Practice Address - Phone:410-869-4602
Practice Address - Fax:410-869-4603
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR133965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD643706Medicaid