MEDICARE: RAUL MENDELOVICI 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	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	32289	CT
2	207V00000X	Obstetrics & Gynecology Physician	32289	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205834363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAUL MENDELOVICI MD

Provider Business Mailing Address
First Line	:	1000 ASYLUM AVE
Second Line	:	SUITE 4309 A
City	:	HARTFORD
State	:	CT
Zip	:	06105-1770
Country	:	US
Telephone Number	:	860-714-6581
Fax Number	:	860-714-8311

Provider Business Practice Location Address
First Line	:	580 COTTAGE GROVE RD
Second Line	:	SUITE 205
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3088
Country	:	US
Telephone Number	:	860-286-2996
Fax Number	:	860-286-0862

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	05/11/2023

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Directions to “ RAUL MENDELOVICI MD” Practice Location

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