Provider Demographics
NPI:1982783890
Name:MESA, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MESA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:M
Other - Last Name:MESA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 S ORANGE AVE STE 255
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5817
Mailing Address - Country:US
Mailing Address - Phone:973-486-4862
Mailing Address - Fax:973-255-2799
Practice Address - Street 1:200 S ORANGE AVE STE 255
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-486-4862
Practice Address - Fax:973-255-2799
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4377372086S0122X
MI53150470862086S0122X
ALMD.309462086S0122X
NJ25MA091985002086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051117726OtherBCBS
AL051117730OtherBCBS
AL129547Medicaid
AL129548Medicaid
AL129551Medicaid
AL129553Medicaid
AL129555Medicaid
AL051117728OtherBCBS
AL051117729OtherBCBS
MS03781821Medicaid
AL051117727OtherBCBS
AL102I244756Medicare PIN