Provider Demographics
NPI:1225355142
Name:MENDIOLA, MONICA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:LEE
Last Name:MENDIOLA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10 GOVE ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1920
Mailing Address - Country:US
Mailing Address - Phone:617-569-5800
Mailing Address - Fax:617-568-4418
Practice Address - Street 1:20 MAVERICK SQ
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2335
Practice Address - Country:US
Practice Address - Phone:617-569-5800
Practice Address - Fax:617-568-4418
Is Sole Proprietor?:No
Enumeration Date:2010-05-02
Last Update Date:2023-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA247979207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB106144Medicare PIN