MEDICARE: DR. MARK P MENOLASCINO 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	207R00000X	Internal Medicine Physician	6730A	WY

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	:	1467566117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK P MENOLASCINO MD

Provider Business Mailing Address
First Line	:	PO BOX 4816
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-4816
Country	:	US
Telephone Number	:	307-732-1039
Fax Number	:

Provider Business Practice Location Address
First Line	:	5235 HHR RANCH ROAD
Second Line	:
City	:	WILSON
State	:	WY
Zip	:	83014-0000
Country	:	US
Telephone Number	:	307-732-1039
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	06/17/2016

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