MEDICARE: DR. KEVIN BRADLEY MERCURE MD

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	207RG0100X	Gastroenterology Physician	0101247297	VA
2	207RG0100X	Gastroenterology Physician	200300846	NC

General Provider Information

NPI Number	:	1598767402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN BRADLEY MERCURE MD

Provider Business Mailing Address
First Line	:	3816 SUNSCAPE DR APT 402
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3175
Country	:	US
Telephone Number	:	540-597-8374
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 MARTHA JEFFERSON DR
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22911-4668
Country	:	US
Telephone Number	:	434-654-5260
Fax Number	:	844-340-9731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	05/07/2025

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