Provider Demographics
NPI:1386296069
Name:MERCADO OLIVARES, FELIPE ALONSO (MD)
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:ALONSO
Last Name:MERCADO OLIVARES
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 1:817 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1539
Mailing Address - Country:US
Mailing Address - Phone:856-263-9439
Mailing Address - Fax:
Practice Address - Street 1:817 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1539
Practice Address - Country:US
Practice Address - Phone:856-583-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
NJ25MA11847200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program