Healthcare Provider Details

I. General information

NPI: 1629020524
Provider Name (Legal Business Name): MERCEDES PACHECO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERCEDES P MURPHY MD

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 N MAIN ST
PROVIDENCE RI
02904-5719
US

IV. Provider business mailing address

22 LAUREL ST APT 16
SOMERVILLE MA
02143-2840
US

V. Phone/Fax

Practice location:
  • Phone: 401-415-4200
  • Fax:
Mailing address:
  • Phone: 603-828-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13437
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD14577
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number250361
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: