MEDICARE: MARELYN MEDINA MD

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	208800000X	Urology Physician	J9759	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	340017711	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	3196639	OTHER	BCBS BLUE LINK
3	82010Y	OTHER	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1258210001	OTHER	PALMETTO DME

General Provider Information

NPI Number	:	1154314342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARELYN MEDINA MD

Provider Business Mailing Address
First Line	:	412 E DOVE AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2240
Country	:	US
Telephone Number	:	956-686-7243
Fax Number	:	956-668-7123

Provider Business Practice Location Address
First Line	:	412 E DOVE AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2240
Country	:	US
Telephone Number	:	956-686-7243
Fax Number	:	956-668-7123

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	10/25/2017

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Directions to “ MARELYN MEDINA MD” Practice Location

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