Provider Demographics
NPI:1235211558
Name:MENDOZA, ARTEMIO JOHN CARAVANA JR (MD)
Entity Type:Individual
Prefix:
First Name:ARTEMIO
Middle Name:JOHN CARAVANA
Last Name:MENDOZA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-742-7025
Mailing Address - Fax:603-742-7053
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-742-7025
Practice Address - Fax:603-742-7053
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11925207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1235211558Medicaid
NHP00167496OtherRAILROAD MEDICARE
NH3076128Medicaid
ME1235211558Medicaid
NHP00167496OtherRAILROAD MEDICARE