Healthcare Provider Details

I. General information

NPI: 1609860352
Provider Name (Legal Business Name): ELISA J MERCURO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TSIENNETO RD SUITE 100
DERRY NH
03038-1584
US

IV. Provider business mailing address

6 TSIENNETO RD SUITE 100
DERRY NH
03038-1584
US

V. Phone/Fax

Practice location:
  • Phone: 603-537-1300
  • Fax: 603-537-1355
Mailing address:
  • Phone: 603-537-1300
  • Fax: 603-537-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12395
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: