Healthcare Provider Details

I. General information

NPI: 1114102829
Provider Name (Legal Business Name): A T MERCURI DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 MONROE AVE SUITE 205
DUNMORE PA
18509-2477
US

IV. Provider business mailing address

1416 MONROE AVE SUITE 205
DUNMORE PA
18509-2477
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-8686
  • Fax: 570-344-2841
Mailing address:
  • Phone: 570-344-8686
  • Fax: 570-344-2841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSC001586L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier801213
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY HEALTH
# 2
Identifier0015392210001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. ANTHONY T MERCURI JR.
Title or Position: OWNER
Credential: D.P.M.
Phone: 570-344-8686