Provider Demographics
NPI:1265604987
Name:MARELYN MEDINA MD & ASSOCIATES PA
Entity type:Organization
Organization Name:MARELYN MEDINA MD & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-686-7243
Mailing Address - Street 1:412 E DOVE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2240
Mailing Address - Country:US
Mailing Address - Phone:956-686-7243
Mailing Address - Fax:956-686-8067
Practice Address - Street 1:412 E DOVE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2240
Practice Address - Country:US
Practice Address - Phone:956-686-7243
Practice Address - Fax:956-668-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00940UOtherMEDICARE
TX00940UOtherMEDICARE