Provider Demographics
NPI:1609049709
Name:MENDIBLE, MARIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:
Last Name:MENDIBLE
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 1:603 BEAMAN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2650
Mailing Address - Country:US
Mailing Address - Phone:910-596-6113
Mailing Address - Fax:910-596-6114
Practice Address - Street 1:603 BEAMAN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2650
Practice Address - Country:US
Practice Address - Phone:910-596-6113
Practice Address - Fax:910-596-6114
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME018289208600000X
NC2014-02180208600000X
PAMT183486208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery