Provider Demographics
NPI:1851608053
Name:ROLANDO J MENENDEZ MD PA
Entity Type:Organization
Organization Name:ROLANDO J MENENDEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-787-4235
Mailing Address - Street 1:733 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4441
Mailing Address - Country:US
Mailing Address - Phone:352-365-2221
Mailing Address - Fax:352-365-2227
Practice Address - Street 1:733 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4441
Practice Address - Country:US
Practice Address - Phone:352-365-2221
Practice Address - Fax:352-365-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDL575AMedicare UPIN
FLF75758Medicare UPIN
FL23878YMedicare UPIN