Provider Demographics
NPI:1134338858
Name:MENDOZA, VINIA MADONNA CASTILLO (MD)
Entity type:Individual
Prefix:DR
First Name:VINIA MADONNA
Middle Name:CASTILLO
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WHITEHALL ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867
Mailing Address - Country:US
Mailing Address - Phone:603-335-0909
Mailing Address - Fax:
Practice Address - Street 1:21 WHITEHALL RD STE 302
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3236
Practice Address - Country:US
Practice Address - Phone:603-335-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME018708207RP1001X
NH18077207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH18077OtherSTAE BOARD OF MEDICINE
NH3107974Medicaid