Provider Demographics
NPI:1700879228
Name:MERCADO MERCADO, SALVADOR SR (MD)
Entity Type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:
Last Name:MERCADO MERCADO
Suffix:SR
Gender:M
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:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0127
Mailing Address - Country:US
Mailing Address - Phone:787-614-1929
Mailing Address - Fax:787-614-1929
Practice Address - Street 1:SANTA ROSA AVE. AGUAS BUENAS
Practice Address - Street 2:BLQ. 16 OFICINA 34
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-614-1929
Practice Address - Fax:787-614-1929
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR58392085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC68758Medicare UPIN