Provider Demographics
NPI:1750646360
Name:MENDOZA, ERNESTO POLICARPIO SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:POLICARPIO
Last Name:MENDOZA
Suffix:SR
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 1:109 FLYING EBONY PL
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2355
Mailing Address - Country:US
Mailing Address - Phone:443-205-5000
Mailing Address - Fax:
Practice Address - Street 1:109 FLYING EBONY PL
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2355
Practice Address - Country:US
Practice Address - Phone:443-205-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0007003171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist