Healthcare Provider Details

I. General information

NPI: 1033193982
Provider Name (Legal Business Name): MARK R MERCURIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST YNHH CHILDREN'S HOSPITAL, 2ND FLOOR
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

20 YORK ST YNHH CHILDREN'S HOSPITAL, 2ND FLOOR
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2320
  • Fax: 203-688-5426
Mailing address:
  • Phone: 203-785-2320
  • Fax: 203-688-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number026775
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: