Healthcare Provider Details

I. General information

NPI: 1003006800
Provider Name (Legal Business Name): BRIDGIT ANN MENA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL PL ORTHOPEDIC AND JOINT REPLACEMENT
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

301 SAINT PAUL PL MEDICAL STAFF OFFICE
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-539-2227
  • Fax:
Mailing address:
  • Phone: 410-659-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003527
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: