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General NPI Number Information
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NPI Number | 1619903556
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Entity Type | Individual
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Provider Name | MARK M MENENDEZ D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 12100 BLACK SWAN DR STE 201
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City | LEWES
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State | DE
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Zip | 19958-4991
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Country | US
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Telephone | 302-644-3311
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Fax | 302-644-3300
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Provider Business Mailing Address
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Address Line | 211 EXECUTIVE DR STE 11
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City | NEWARK
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State | DE
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Zip | 19702-3358
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Country | US
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Telephone | 302-731-2888
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Fax | 302-731-7049
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E10000140
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License Number State | DE
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