Provider Demographics
NPI:1548314891
Name:MERCALDI, ROGER E III (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:E
Last Name:MERCALDI
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1553
Mailing Address - Country:US
Mailing Address - Phone:978-526-8400
Mailing Address - Fax:978-526-8411
Practice Address - Street 1:40 UNION ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1553
Practice Address - Country:US
Practice Address - Phone:978-526-8400
Practice Address - Fax:978-526-8411
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36648OtherBLUE CROSS BLUE SHIELD
MAAA69506OtherHARVARD PILGRIM, UNITED
MAP00206803OtherRAILROAD MEDICARE
MAY36648OtherBLUE CROSS BLUE SHIELD