Provider Demographics
NPI:1255374856
Name:MENDOZA, DAVID C (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 18TH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3231
Mailing Address - Country:US
Mailing Address - Phone:304-424-4593
Mailing Address - Fax:304-424-4017
Practice Address - Street 1:604 ANN ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5122
Practice Address - Country:US
Practice Address - Phone:304-865-5155
Practice Address - Fax:304-865-5156
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18562208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00361091OtherRAILROAD MEDICARE
WV00891585OtherBLUE CROS BLUE SHIELD
WV00368861OtherRAILROAD MEDICARE
WV0130407000Medicaid
WV005292138OtherAETNA
OH0276339Medicaid
WV00368861OtherRAILROAD MEDICARE
WV0806101Medicare ID - Type Unspecified
WV005292138OtherAETNA