Healthcare Provider Details

I. General information

NPI: 1689223547
Provider Name (Legal Business Name): INEZ MERCER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: INECITA MERCER

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E FORT AVE
BALTIMORE MD
21230-4628
US

IV. Provider business mailing address

1002 SITHEAN WAY
GLEN BURNIE MD
21060-8391
US

V. Phone/Fax

Practice location:
  • Phone: 443-708-7673
  • Fax:
Mailing address:
  • Phone: 703-615-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26658
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: