Provider Demographics
NPI:1508016205
Name:ETERNAMD
Entity Type:Organization
Organization Name:ETERNAMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-771-0404
Mailing Address - Street 1:1307 S INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE #2091
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1413
Mailing Address - Country:US
Mailing Address - Phone:407-771-0404
Mailing Address - Fax:407-771-0405
Practice Address - Street 1:1307 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE #2091
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1413
Practice Address - Country:US
Practice Address - Phone:407-771-0404
Practice Address - Fax:407-771-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73229170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty