Provider Demographics
NPI:1245326636
Name:MENDEZ, MARIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MENDEZ
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 1:235 N BROAD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1511
Mailing Address - Country:US
Mailing Address - Phone:215-762-7785
Mailing Address - Fax:215-568-6007
Practice Address - Street 1:235 N BROAD ST
Practice Address - Street 2:SUITE 200 CLINICAL NEPHROLOGY ASSOC
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1511
Practice Address - Country:US
Practice Address - Phone:215-762-7785
Practice Address - Fax:215-568-6007
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031178E207RN0300X
NJ25MA06001600207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001048340Medicaid
PAME180719Medicare ID - Type Unspecified
PA001048340Medicaid