Provider Demographics
NPI:1568441780
Name:MENDEZ, CONSUELO A (MD)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:A
Last Name:MENDEZ
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 1:2955 CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-2804
Mailing Address - Country:US
Mailing Address - Phone:330-270-0118
Mailing Address - Fax:330-270-0120
Practice Address - Street 1:2955 CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-2804
Practice Address - Country:US
Practice Address - Phone:330-270-0118
Practice Address - Fax:330-270-0120
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054678M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0669914Medicaid
OH0602803Medicare ID - Type Unspecified
OH0669914Medicaid