MEDICARE: MATTHEW M MONDI 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	208600000X	Surgery Physician	2004-00150	NC
2	208600000X	Surgery Physician	060940	GA

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
2	7406921	OTHER	NC	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	808466	OTHER	NC	PARTNERS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	190681	OTHER	NC	MEDCOST
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1429K	OTHER	NC	BLUE CROSS

General Provider Information

NPI Number	:	1720092471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW M MONDI MD

Provider Business Mailing Address
First Line	:	PO BOX 1705
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30903-1705
Country	:	US
Telephone Number	:	706-854-6008
Fax Number	:	706-774-7230

Provider Business Practice Location Address
First Line	:	818 SAINT SEBASTIAN WAY STE 104
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2652
Country	:	US
Telephone Number	:	706-434-0130
Fax Number	:

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	01/10/2023

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Directions to “ MATTHEW M MONDI MD” Practice Location

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