Healthcare Provider Details

I. General information

NPI: 1659301638
Provider Name (Legal Business Name): MERCEDES E AGUDO MD, LFAPA, DFAACAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 N READING RD
EPHRATA PA
17522-1651
US

IV. Provider business mailing address

720 GREENTREE VLG
LEBANON PA
17042-6942
US

V. Phone/Fax

Practice location:
  • Phone: 717-738-1125
  • Fax: 717-738-0606
Mailing address:
  • Phone: 717-903-2985
  • Fax: 223-241-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD420230
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD420230
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: