Provider Demographics
NPI:1275730111
Name:MENDENHALL, MARGARETTA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARETTA
Middle Name:LYNN
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ROCLARE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1100
Mailing Address - Country:US
Mailing Address - Phone:314-517-0178
Mailing Address - Fax:
Practice Address - Street 1:300 WINDING WOODS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4771
Practice Address - Country:US
Practice Address - Phone:636-240-0130
Practice Address - Fax:636-240-6822
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011009917207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology