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General NPI Number Information
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NPI Number | 1053776120
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Entity Type | Organization
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Legal Business Name | PHILIP G. MONDI, M.D., P.A.
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 80 AVIEMORE CT SUITE C
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City | PINEHURST
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State | NC
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Zip | 28374-9732
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Country | US
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Telephone | 910-235-3195
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Fax | 910-235-3431
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Provider Business Mailing Address
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Address Line | 80 AVIEMORE CT SUITE C
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City | PINEHURST
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State | NC
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Zip | 28374-9732
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Country | US
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Telephone | 910-235-3195
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Fax | 910-235-3431
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PHILIP G MONDI
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Credential | M.D.
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Telephone | 910-235-3195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 9601769
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License Number State | NC
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