Healthcare Provider Details

I. General information

NPI: 1710349345
Provider Name (Legal Business Name): JOSHUA LOGIN MENA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-6300
US

IV. Provider business mailing address

4107 SALFORD CT
BENSALEM PA
19020-4835
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1000
  • Fax:
Mailing address:
  • Phone: 860-460-7512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS020957
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: