Healthcare Provider Details

I. General information

NPI: 1003966896
Provider Name (Legal Business Name): GEORGE A MERCADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 FOREST AVE
MAYSVILLE KY
41056-1411
US

IV. Provider business mailing address

611 FOREST AVE
MAYSVILLE KY
41056-1411
US

V. Phone/Fax

Practice location:
  • Phone: 606-564-4016
  • Fax: 606-564-8288
Mailing address:
  • Phone: 606-564-4016
  • Fax: 606-564-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number42982
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: