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General NPI Number Information
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NPI Number | 1144260126
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Entity Type | Individual
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Provider Name | TRACEYAN R. MENDEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 750 ROUTE 739
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City | LORDS VALLEY
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State | PA
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Zip | 18428-6058
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Country | US
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Telephone | 570-775-7100
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Fax | 570-775-0950
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Provider Business Mailing Address
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Address Line | PO BOX 783311
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City | PHILADELPHIA
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State | PA
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Zip | 19178-3311
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Country | US
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Telephone | 484-884-4500
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Fax | 484-884-0699
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 057831
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD453022
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License Number State | PA
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