Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 3279 | SC |
NPI | 1114092343 |
---|---|
Provider Name | Mr. Thomas William Mercante |
First Address | Elmont, NY 11003 |
Second Address | Summerville, SC 29483-3072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 06/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U62327 | (02) |