Provider Demographics
NPI:1457521791
Name:MERCY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-385-3270
Mailing Address - Street 1:301 ST. PAUL PLACE MERCY MEDICAL CENTER
Mailing Address - Street 2:DENTAL DEPT.
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202
Mailing Address - Country:US
Mailing Address - Phone:410-385-3270
Mailing Address - Fax:410-545-4253
Practice Address - Street 1:301 ST. PAUL PLACE MERCY MEDICAL CENTER
Practice Address - Street 2:DENTAL DEPT.
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:410-332-9262
Practice Address - Fax:410-545-4253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420804800Medicaid