MEDICARE: RENARD MERCURIO L. AC.

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	171100000X	Acupuncturist	554	NC

General Provider Information

NPI Number	:	1699022574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENARD MERCURIO L. AC.

Provider Business Mailing Address
First Line	:	1112 HARDING PL
Second Line	:	SUITE # 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2896
Country	:	US
Telephone Number	:	704-706-7824
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 HARDING PL
Second Line	:	SUITE # 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2896
Country	:	US
Telephone Number	:	704-706-7824
Fax Number	:

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

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	08/09/2012

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