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General NPI Number Information
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NPI Number | 1851842363
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Entity Type | Organization
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Legal Business Name | MELCHOR L. MERCADO M.D. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 1250 RALSTON AVE
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City | DEFIANCE
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State | OH
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Zip | 43512-5311
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Country | US
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Telephone | 419-783-7880
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Fax | 419-783-6804
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Provider Business Mailing Address
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Address Line | 1250 RALSTON AVE
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City | DEFIANCE
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State | OH
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Zip | 43512-5311
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Country | US
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Telephone | 419-783-7880
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Fax | 419-783-6804
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELCHOR L. MERCADO
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Credential | M.D.
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Telephone | 419-783-7880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 35.071066
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License Number State | OH
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