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General NPI Number Information
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NPI Number | 1225212335
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Entity Type | Organization
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Legal Business Name | MENDES MEDICAL ASSOC. PC
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 55 BELGADE AVE
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City | ROSLINDALE
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State | MA
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Zip | 02131-2413
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Country | US
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Telephone | 617-327-7465
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Fax | 617-363-9993
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Provider Business Mailing Address
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Address Line | 55 BELGRADE AVE
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City | ROSLINDALE
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State | MA
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Zip | 02131-2413
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Country | US
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Telephone | 617-327-7465
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Fax | 617-363-9993
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ANTONIO C MENDES
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Credential | M.D
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Telephone | 617-327-7465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 80176
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 80176
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License Number State | MA
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