Provider Demographics
NPI:1215906987
Name:PAGAN MERCADO, KETSY (MD)
Entity type:Individual
Prefix:DR
First Name:KETSY
Middle Name:
Last Name:PAGAN MERCADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KETSY
Other - Middle Name:
Other - Last Name:PAGAN MERCADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:EL VALLE 206
Mailing Address - Street 2:CALLE POMARROSAS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3217
Mailing Address - Country:US
Mailing Address - Phone:787-745-5172
Mailing Address - Fax:787-737-0244
Practice Address - Street 1:CARR 941
Practice Address - Street 2:SALIDA BARRIO JAGUAS
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-4866
Practice Address - Fax:787-737-0244
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14225208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics