Healthcare Provider Details

I. General information

NPI: 1336151182
Provider Name (Legal Business Name): MAX E. MERCADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 CENTRAL AVE SUITE 203
PHILADELPHIA PA
19111-2430
US

IV. Provider business mailing address

7500 CENTRAL AVE SUITE 203
PHILADELPHIA PA
19111-2430
US

V. Phone/Fax

Practice location:
  • Phone: 215-289-4434
  • Fax: 215-289-7442
Mailing address:
  • Phone: 215-289-4434
  • Fax: 215-289-7442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD417192
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: