Provider Demographics
NPI:1982648036
Name:MENDOZA, JOSE L (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:8926 WOODYARD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4220
Mailing Address - Country:US
Mailing Address - Phone:301-868-7911
Mailing Address - Fax:301-868-2285
Practice Address - Street 1:8926 WOODYARD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4220
Practice Address - Country:US
Practice Address - Phone:301-868-7911
Practice Address - Fax:301-868-2285
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0064153207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1293056OtherAETNA HMO
3154546OtherMAMSI
MD88874602OtherBC/BS MD - GREENBELT
DC02810007OtherBC/BS OF DC
MD88874601OtherBC/BS MD - CLINTON
5258642OtherCIGNA
3154546OtherALLIANCE
MD021213000Medicaid
DCB6480006OtherBC/BS OF DC
DC037955300Medicaid
MD88874602OtherBC/BS MD - GREENBELT
3154546OtherMAMSI
I69183Medicare UPIN
P00373093Medicare PIN