Provider Demographics
NPI:1891085213
Name:JOHN J. MERENDINO, JR., M.D., PA
Entity Type:Organization
Organization Name:JOHN J. MERENDINO, JR., M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MERENDINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:301-230-0300
Mailing Address - Street 1:10215 FERNWOOD ROAD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-230-0300
Mailing Address - Fax:301-230-0314
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:SUITE 405
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-230-0300
Practice Address - Fax:301-230-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD36046207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF10495Medicare UPIN