Provider Demographics
NPI:1396734497
Name:MERCADO-STALLARD, BARBARA (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:MERCADO-STALLARD
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 1:50 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1534
Mailing Address - Country:US
Mailing Address - Phone:207-664-5650
Mailing Address - Fax:207-664-5651
Practice Address - Street 1:50 UNION ST STE 3200
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1534
Practice Address - Country:US
Practice Address - Phone:207-664-5650
Practice Address - Fax:207-664-5651
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059310207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6213847Medicaid
VA160001647Medicare PIN
VA6213847Medicaid