Provider Demographics
NPI:1891779054
Name:MENENDEZ, MERCEDES ELVIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:ELVIRA
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 415438
Mailing Address - Street 2:UMASS MEMORIAL MEDICAL GROUP, INC.
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-2225
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:55 LAKE AVENUE NORTH
Practice Address - Street 2:UMASS MEMORIAL MEDICAL CENTER, ADULT MENTAL HEALTH UNIT
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:774-442-2761
Practice Address - Fax:774-442-8357
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2066402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0118150Medicaid
MA206640OtherMEDICAL LICENSE #
H05513Medicare UPIN
A32053Medicare PIN