MEDICARE: THOMAS F MENDOLIA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	34401	NC

General Provider Information

NPI Number	:	1194782748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS F MENDOLIA D.O.

Provider Business Mailing Address
First Line	:	114 ELDRIDGE LN
Second Line	:
City	:	STATE ROAD
State	:	NC
Zip	:	28676-8754
Country	:	US
Telephone Number	:	336-835-5688
Fax Number	:	336-835-6521

Provider Business Practice Location Address
First Line	:	201 W MAIN ST
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-3446
Country	:	US
Telephone Number	:	336-835-5688
Fax Number	:	336-835-6521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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Directions to “ THOMAS F MENDOLIA D.O.” Practice Location

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