Provider Demographics
NPI:1760511430
Name:MENDES, JOSEPH VIRGILIO (PA-C, RRT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:VIRGILIO
Last Name:MENDES
Suffix:
Gender:M
Credentials:PA-C, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:30 SHADY HILL LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1786
Mailing Address - Country:US
Mailing Address - Phone:860-632-1215
Mailing Address - Fax:
Practice Address - Street 1:800 HOWARD AVE
Practice Address - Street 2:OTOLARYNGOLOGY 4TH FLOOR YALE PHYSICIAN BLDG
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-785-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001331363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical