MEDICARE: ELSA MONDOU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	36232	NC

General Provider Information

NPI Number	:	1134651748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSA MONDOU

Provider Business Mailing Address
First Line	:	6008 BUNCHBERRY CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-5454
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6008 BUNCHBERRY CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-5454
Country	:	US
Telephone Number	:	919-624-7880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2017
Last Update Date	:	04/02/2017

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Directions to “ ELSA MONDOU ” Practice Location

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