Provider Demographics
NPI:1841251162
Name:MENDOZA, ANTONIA A (MD)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:A
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 1:1200 BROOKS LANE
Mailing Address - Street 2:SUITE 285
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3747
Mailing Address - Country:US
Mailing Address - Phone:412-469-6956
Mailing Address - Fax:412-469-3799
Practice Address - Street 1:1200 BROOKS LANE
Practice Address - Street 2:SUITE 285
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3747
Practice Address - Country:US
Practice Address - Phone:412-469-6956
Practice Address - Fax:412-469-3799
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD050518L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015425950002Medicaid
PA0015425950002Medicaid
PAF99821Medicare UPIN