Look up the most recent NPI and PECOS records

Mercury Medical

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

PECOS Enrollment

Based on the most recent information from CMS, provider Mercury Medical does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1598015208
Provider Type
Organization
Full Name
Mercury Medical

Subpart
No
Enumeration Date
9/11/2012
Last Updated
9/11/2012

Contact Information

Practice Location

171 Grove Pl, West Haven, CT 06516-6438

(616) 690-1835

Unlisted Fax

Mailing Location

171 Grove Pl, West Haven, CT 06516-6438

(616) 690-1835

Unlisted Fax

Authorized Official

Sewell, Richard Andrew (President)

(616) 690-1835

Provider Taxonomies

Code	Description	License
Code 2084P0800X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License 045978 Connecticut
Code 1041C0700X	Description Social Worker Behavioral Health & Social Service Providers	License 007163 Connecticut
Code 2084N0400X	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License 045978 Connecticut

Mercury Medical

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Lin, Hong Ju

Goodson, Susan

Roy, Kamolika

D'Souza, Deepak Cyril

Lazzarini, Kathleen M

Wu, Stephanie

Hannestad, Jonas O'Gara

Perez Palmer, Nicolas Andre

Godleski, Linda Susan

Arnaout, Bachaar