Provider Demographics
NPI:1427050277
Name:MERCADO, MYRA E (MD)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:E
Last Name:MERCADO
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 SAW MILL RIVER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1533
Mailing Address - Country:US
Mailing Address - Phone:914-493-8558
Mailing Address - Fax:914-493-1488
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:WESTCHESTER MEDICAL CENTER-PEDIATRICS
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-493-8558
Practice Address - Fax:914-493-1488
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1884742080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01369295Medicaid
NY01369295Medicaid
NY74K291Medicare PIN
NY01369295Medicaid