Provider Demographics
NPI:1184899700
Name:MERCADE, FERNANDA LIDIA (MD)
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:LIDIA
Last Name:MERCADE
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 1:747 PONCE DE LEON BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2073
Mailing Address - Country:US
Mailing Address - Phone:864-422-1007
Mailing Address - Fax:864-422-1017
Practice Address - Street 1:747 PONCE DE LEON BLVD STE 405
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2073
Practice Address - Country:US
Practice Address - Phone:864-422-1007
Practice Address - Fax:786-442-2101
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000340600Medicaid
FLAX504ZMedicare PIN