MEDICARE: DR. EDITH MENSA M.D.

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	207Q00000X	Family Medicine Physician	ME0069717	FL

General Provider Information

NPI Number	:	1700807062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDITH MENSA M.D.

Provider Business Mailing Address
First Line	:	631 PALM SPRINGS DR
Second Line	:	SUITE 117
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-7854
Country	:	US
Telephone Number	:	407-339-5600
Fax Number	:	407-339-5602

Provider Business Practice Location Address
First Line	:	631 PALM SPRINGS DR
Second Line	:	SUITE 117
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-7854
Country	:	US
Telephone Number	:	407-339-5600
Fax Number	:	407-339-5602

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	08/23/2010

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Directions to “ DR. EDITH MENSA M.D.” Practice Location

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