Provider Demographics
NPI:1235303314
Name:MATTHEW M. MONDI, P.C.
Entity Type:Organization
Organization Name:MATTHEW M. MONDI, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-724-5451
Mailing Address - Street 1:1430 HARPER ST
Mailing Address - Street 2:BUILDING B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-0617
Mailing Address - Country:US
Mailing Address - Phone:706-724-5451
Mailing Address - Fax:
Practice Address - Street 1:1430 HARPER ST
Practice Address - Street 2:BUILDING B
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-0617
Practice Address - Country:US
Practice Address - Phone:706-724-5451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00435405OtherRAILROAD MEDICARE PIN
WV3810008155Medicaid
NC190681OtherMEDCOST
NC808466OtherPARTNERS
NC7406921OtherAETNA
VA10409292Medicaid
NC2679309OtherUNITED HEALTHCARE
NC5905895Medicaid
SCQ0015HMedicaid
NC1429KOtherBLUE CROSS
I71634Medicare UPIN
NC2062914Medicare PIN