Provider Demographics
NPI:1205126638
Name:PALMISANO, MERCEDES CATERINA (MD)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:CATERINA
Last Name:PALMISANO
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 1:1 WYOMING ST
Mailing Address - Street 2:STE 4140
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-4100
Mailing Address - Fax:937-208-6260
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:STE 4140
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-4100
Practice Address - Fax:937-208-6260
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.125616207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program