Provider Demographics
NPI:1578612644
Name:MENDIGUREN, IGNACIO INAKI (MD)
Entity Type:Individual
Prefix:
First Name:IGNACIO
Middle Name:INAKI
Last Name:MENDIGUREN
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:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:VA
Mailing Address - Zip Code:20197
Mailing Address - Country:US
Mailing Address - Phone:703-669-5962
Mailing Address - Fax:703-669-5963
Practice Address - Street 1:44055 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5179
Practice Address - Country:US
Practice Address - Phone:703-858-6900
Practice Address - Fax:703-858-6900
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044605207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005858160Medicaid
C09801Medicare ID - Type Unspecified