Provider Demographics
NPI:1992844583
Name:MERCADO, GEMMA MIRANDA (MD)
Entity type:Individual
Prefix:DR
First Name:GEMMA
Middle Name:MIRANDA
Last Name:MERCADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GEMMA
Other - Middle Name:G
Other - Last Name:MIRANDA-MERCADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:NAVAL HOSPITAL GUAM
Mailing Address - Street 2:PSC 490, BOX 9024
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96538
Mailing Address - Country:US
Mailing Address - Phone:671-471-6025
Mailing Address - Fax:
Practice Address - Street 1:388 YPAO RD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3701
Practice Address - Country:US
Practice Address - Phone:671-646-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine