Provider Demographics
NPI:1740259936
Name:WOLDEYOHANNES, MENTESINOT (MD, MPH)
Entity type:Individual
Prefix:
First Name:MENTESINOT
Middle Name:
Last Name:WOLDEYOHANNES
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-0130
Mailing Address - Fax:585-922-0142
Practice Address - Street 1:10 HAGEN DR STE 240
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2659
Practice Address - Country:US
Practice Address - Phone:585-922-0130
Practice Address - Fax:585-922-0142
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208196207RP1001X, 207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01824560Medicaid
NYBB0208Medicare ID - Type Unspecified
NY01824560Medicaid