Provider Demographics
NPI:1578533667
Name:MENDICINO, ROBERT WILLIAM (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:MENDICINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E TOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4601
Mailing Address - Country:US
Mailing Address - Phone:614-788-5000
Mailing Address - Fax:614-788-5100
Practice Address - Street 1:303 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4601
Practice Address - Country:US
Practice Address - Phone:614-788-5000
Practice Address - Fax:614-788-5100
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003270L213E00000X, 213ES0103X, 213ES0131X
NC567213ES0103X
OH36.003654213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011607060006Medicaid
OH3026504Medicaid
PA0011607060006Medicaid
PA5757580003Medicare NSC
PAT84849Medicare UPIN
PA5757580001Medicare NSC
PA137851VSLMedicare PIN
OH3026504Medicaid
PA5757580004Medicare NSC