MEDICARE: MERCY MEDICAL CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1316627771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY MEDICAL CLINIC PA

Provider Business Mailing Address
First Line	:	9510 UNIVERSITY CITY BLVD STE 102
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-3997
Country	:	US
Telephone Number	:	704-833-8037
Fax Number	:	704-691-0415

Provider Business Practice Location Address
First Line	:	9510 UNIVERSITY CITY BLVD STE 102
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-3997
Country	:	US
Telephone Number	:	704-833-8037
Fax Number	:	704-691-0415

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. LANRE LADIPO
Credential	:
Telephone Number	:	704-833-8037

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	03/13/2026

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Directions to “MERCY MEDICAL CLINIC PA ” Practice Location

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