MEDICARE: DR. ERNESTO M MENDOZA JR. M.D.

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	207Q00000X	Family Medicine Physician	D0050763	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578515037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNESTO M MENDOZA JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 900
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21158-0900
Country	:	US
Telephone Number	:	410-848-2444
Fax Number	:	410-857-1634

Provider Business Practice Location Address
First Line	:	826 WASHINGTON RD
Second Line	:	SUITE 120
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-5750
Country	:	US
Telephone Number	:	410-848-2444
Fax Number	:	410-857-1634

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	01/22/2013

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Directions to “ DR. ERNESTO M MENDOZA JR. M.D.” Practice Location

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