Provider Demographics
NPI:1518060664
Name:MEJIA, MARIO CORDOVA (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:CORDOVA
Last Name:MEJIA
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 1:2000 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-234-8663
Mailing Address - Fax:304-234-8960
Practice Address - Street 1:92 N 4TH ST
Practice Address - Street 2:SUITE 18
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1691
Practice Address - Country:US
Practice Address - Phone:740-633-4305
Practice Address - Fax:740-633-4178
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0330903Medicaid
WV0049153000Medicaid
110128188OtherRAILROAD MEDICARE
110128188OtherRAILROAD MEDICARE
A75639Medicare UPIN