Healthcare Provider Details

I. General information

NPI: 1437185501
Provider Name (Legal Business Name): HEDLEY N MENDEZ III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BREEZY POINT RD
POQUOSON VA
23662-1119
US

IV. Provider business mailing address

7 BREEZY POINT RD
POQUOSON VA
23662-1119
US

V. Phone/Fax

Practice location:
  • Phone: 757-868-8622
  • Fax: 757-868-8622
Mailing address:
  • Phone: 757-868-8622
  • Fax: 757-868-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number98009688
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: