Provider Demographics
NPI:1023126307
Name:DR MARIO C MEJIA PC
Entity type:Organization
Organization Name:DR MARIO C MEJIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR MARIO C MEJIA PC
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-633-4305
Mailing Address - Street 1:92 N 4TH ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1691
Mailing Address - Country:US
Mailing Address - Phone:740-633-4305
Mailing Address - Fax:740-633-4178
Practice Address - Street 1:92 N 4TH ST
Practice Address - Street 2:SUITE 18
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1691
Practice Address - Country:US
Practice Address - Phone:740-633-4305
Practice Address - Fax:740-633-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH39407F207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
39407FOtherHP
9329991Medicare ID - Type Unspecified
A75639Medicare UPIN