Provider Demographics
NPI:1548388150
Name:JORGE A MONDINO, M. D., P.C.
Entity Type:Organization
Organization Name:JORGE A MONDINO, M. D., P.C.
Other - Org Name:JORGE A MONDINO, M.D., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONDINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-567-2330
Mailing Address - Street 1:6192 OXON HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3114
Mailing Address - Country:US
Mailing Address - Phone:301-567-2330
Mailing Address - Fax:301-839-0828
Practice Address - Street 1:6192 OXON HILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3114
Practice Address - Country:US
Practice Address - Phone:301-567-2330
Practice Address - Fax:301-839-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024059207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00643431Medicaid
VA00643431Medicaid
193346Medicare PIN