Provider Demographics
NPI:1104893197
Name:MERCADO RODRIGUEZ, SALVADOR (MD)
Entity type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:
Last Name:MERCADO RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-0900
Mailing Address - Country:US
Mailing Address - Phone:787-914-9326
Mailing Address - Fax:787-200-4670
Practice Address - Street 1:172-16 CALLE 438
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-3510
Practice Address - Country:US
Practice Address - Phone:787-914-9326
Practice Address - Fax:787-200-4670
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14636208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92695Medicare UPIN