Provider Demographics
NPI:1265470777
Name:UROLOGY ASSOCIATES INC.
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-485-7700
Mailing Address - Street 1:418 GRAND PARK DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4000
Mailing Address - Country:US
Mailing Address - Phone:304-485-7700
Mailing Address - Fax:304-485-5141
Practice Address - Street 1:418 GRAND PARK DR
Practice Address - Street 2:SUITE 311
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-4000
Practice Address - Country:US
Practice Address - Phone:304-485-7700
Practice Address - Fax:304-485-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01011208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0710930Medicaid
WV0008738000Medicaid
WVCE5112OtherRAILROAD MEDICARE
OH0710930Medicaid