Provider Demographics
NPI:1982447389
Name:MERCENE, KRISTINE GLORY FLORES (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE GLORY
Middle Name:FLORES
Last Name:MERCENE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINE GLORY
Other - Middle Name:SANCHEZ
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2050 W OGDEN AVE APT 707
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-5608
Mailing Address - Country:US
Mailing Address - Phone:909-550-9880
Mailing Address - Fax:
Practice Address - Street 1:1201 LANGHORNE NEWTOWN RD STE 1
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1295
Practice Address - Country:US
Practice Address - Phone:215-710-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
IL125084237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine