Basic Information
| Provider Information | |||||||||
| NPI: | 1578628715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERCADO | ||||||||
| FirstName: | GLORIA | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 387 QUARRY ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027231025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086798111 | ||||||||
| FaxNumber: | 5086745028 | ||||||||
| Practice Location | |||||||||
| Address1: | 387 QUARRY ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027231025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086798111 | ||||||||
| FaxNumber: | 5086745028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 01/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 51934 | MA | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 3003604 | 05 | MA | MEDICAID | 412269 | 01 | RI | BC BS OF RI (BLUECHIP) | OTHER | 44289 | 01 | MA | CHILDREN'S MEDICAL SP | OTHER | 0039507 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 0103124 | 01 | MA | UNITEDHEALTHCARE | OTHER | 210126 | 01 | RI | BC BS OF RI | OTHER | 961245-01 | 01 | MA | NETWORK HEALTH | OTHER | J05037 | 01 | MA | BC BS OF MA | OTHER |