Individual
MARIA-GISELA MERCADO-DEANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
333 N SANTA ROSA ST, SAN ANTONIO, TX 78207-3108
(210) 704-2467
(903) 617-5247
Mailing address
PO BOX 12507, SAN ANTONIO, TX 78212-0507
(210) 704-2467
(903) 617-5247
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
35-086062
OH
2085R0202X
Diagnostic Radiology Physician
Primary
K9129
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000203281
UNISON
OH
01
—
000000503628
ANTHEM
OH
01
—
0304914
BCMH
OH
01
—
1851319057
MI MEDICAID
OH
05
—
2573693
—
OH
01
—
363834
WELLCARE
OH
01
—
3810011339
WV MEDICAID
WV
01
—
4305312
AETNA
OH
01
—
733544
BUCKEYE
OH
Enumeration date
07/17/2006
Last updated
02/25/2016
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