Provider Demographics
NPI:1528070901
Name:MERCER PRIMARY CARE ASSOCIATES LLC
Entity type:Organization
Organization Name:MERCER PRIMARY CARE ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:WARNER
Authorized Official - Last Name:GAUKLER-GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:609-844-0083
Mailing Address - Street 1:123 FRANKLIN CORNER RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2526
Mailing Address - Country:US
Mailing Address - Phone:609-844-0084
Mailing Address - Fax:609-844-0085
Practice Address - Street 1:123 FRANKLIN CORNER RD
Practice Address - Street 2:SUITE 204
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2526
Practice Address - Country:US
Practice Address - Phone:609-844-0084
Practice Address - Fax:609-844-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD 044787L207R00000X
NJMA 049502207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2460904Medicaid
NJ052477Medicare ID - Type Unspecified
E58244Medicare UPIN