Provider Demographics
NPI:1053733154
Name:MERCURIO, DAVID (HIS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MERCURIO
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E 5TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-3218
Mailing Address - Country:US
Mailing Address - Phone:978-244-0081
Mailing Address - Fax:401-921-3327
Practice Address - Street 1:18 NORTH RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2736
Practice Address - Country:US
Practice Address - Phone:978-244-0081
Practice Address - Fax:401-921-3327
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA285237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1598891855Medicaid