Provider Demographics
NPI:1326049099
Name:MENDIONDO, OSCAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:A
Last Name:MENDIONDO
Suffix:
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 1:1401 HARRODSBURG RD
Mailing Address - Street 2:STE A100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-258-6700
Mailing Address - Fax:859-258-6509
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:STE A100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-258-6700
Practice Address - Fax:859-258-6509
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY198072085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64198070Medicaid
KY920006559OtherRR MEDICARE
KY00588001Medicare PIN
KY64198070Medicaid
KY0980Medicare PIN
KYC64427Medicare UPIN
KY920006559OtherRR MEDICARE
KY0169Medicare PIN