Provider Demographics
NPI:1659301638
Name:AGUDO, MERCEDES E (MD, LFAPA, DFAACAP)
Entity type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:E
Last Name:AGUDO
Suffix:
Gender:F
Credentials:MD, LFAPA, DFAACAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 GREENTREE VLG
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6942
Mailing Address - Country:US
Mailing Address - Phone:717-903-2985
Mailing Address - Fax:223-241-2103
Practice Address - Street 1:344 N READING RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1651
Practice Address - Country:US
Practice Address - Phone:717-738-1125
Practice Address - Fax:717-738-0606
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4202302084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ266126Medicaid
PA0019655190001Medicaid
069554GHEMedicare ID - Type Unspecified