Healthcare Provider Details

I. General information

NPI: 1487620712
Provider Name (Legal Business Name): JOSEPH WILLIAM MERCURIO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAIN ST
SAEGERTOWN PA
16433-1129
US

IV. Provider business mailing address

1034 GROVE ST
MEADVILLE PA
16335-2945
US

V. Phone/Fax

Practice location:
  • Phone: 814-763-1106
  • Fax: 814-763-1129
Mailing address:
  • Phone: 814-763-1106
  • Fax: 814-763-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS013482
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: