MARK J. MENDOLLA (NPI# 1679559199) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679559199 |
| Entity Type | Individual |
| Full Name | MARK J. MENDOLLA |
| Credential | MD |
| Practice Address |
1223 Gateway Dr Ste 2f Melbourne FL 32901 |
| Mailing Address |
3300 S Fiske Blvd Rockledge FL 32955-4306 |
| Practice Telephone | 3213123496 |
| Practice Fax Number | 3214092517 |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2020-03-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
ME67965 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS OF FL | 26824 | 01 |
| FL | AETNA | 4671480 | 01 |
| FL | RR MEDICARE | P00768027 | 01 |
| FL | CIGNA | 7905980 | 01 |
| FL | 378231000 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 8725 N Wickham Rd Ste 302, Melbourne, FL 329402240 | 3213123496 | 3214092517 |
| 8725 N Wickham Rd Ste 302, Melbourne, FL 329402240 | 3217254500 | 3214092517 |
| Street Address |
1223 GATEWAY DR STE 2F |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861485518 | Theodore R Amgott | Internal Medicine | 1223 Gateway Dr Ste 2f, Melbourne, FL 32901-2607 | 2005-08-29 |
| 1114469350 | Michelle Lynn Billings Williams | Nurse Practitioner | 1223 Gateway Dr Ste 2f, Melbourne, FL 32901-2607 | 2016-11-04 |
| 1306899026 | Enrique D Polanco | Internal Medicine | 1223 Gateway Dr Ste 2f, Melbourne, FL 32901-2607 | 2006-05-17 |
| 1386603934 | David L. Smull | Internal Medicine | 1223 Gateway Dr Ste 2f, Melbourne, FL 32901 | 2006-03-22 |
| 1528043163 | Prakash V Reddy | Internal Medicine | 1223 Gateway Dr Ste 2f, Melbourne, FL 32901-2607 | 2005-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467062943 | George Pappas | Anesthesiologist Assistant | 1775 W. Hibiscus Blvd., Ste 215, Melbourne, FL 32901 | 2020-08-09 |
| 1124676820 | Abbi Dell Lee | Behavioral Analyst | 3251 Engineering St, Melbourne, FL 32901 | 2019-08-27 |
| 1750856878 | Jeffrey Michael Cavanagh | Behavior Technician | 3251 Engineering Street, Melbourne, FL 32901 | 2018-10-04 |
| 1740766021 | Amanda Miller | Behavior Technician | 1885 W Hibiscus Blvd, Melbourne, FL 32901 | 2018-07-19 |
| 1396244406 | Dragen II LLC | Urology | 129 W Hibiscus Blvd Ste D, Melbourne, FL 32901 | 2018-02-03 |
| 1225550692 | Cabrit Psychotherapy Services LLC | Marriage & Family Therapist | 100 Rialto Place, Suite 700, Melbourne, FL 32901 | 2017-07-07 |
| 1487188058 | Project Response, Inc. | Clinic/Center | 747 S. Apollo Boulevard, Melbourne, FL 32901 | 2017-04-20 |
| 1184174575 | Paulette Swanson | Physical Therapist | 611 East Sheridan Rd, Melbourne, FL 32901 | 2016-10-10 |
| 1841747839 | Nicholas Wilson | Social Worker | 3661 S. Babcock St., Melbourne, FL 32901 | 2016-09-07 |
| 1467804278 | Nickolas Hetherington | Occupational Therapist | 1900 S Harbor City Blvd Ste 108, Melbourne, FL 32901 | 2016-07-05 |
| Find all providers in zip 32901 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902144876 | Ralph M Vicari Md LLC | Internal Medicine | 1437 Pineapple Ave Apt 802, Melbourne, FL 32935-6591 | 2013-01-28 |
| 1932149960 | Chris K Finton | Internal Medicine | 1355 S Hickory St, Suite 202, Melbourne, FL 32901-3228 | 2006-06-07 |
| 1609851245 | James M. Ronaldson | Internal Medicine | 8725 N Wickham Rd Ste 302, Melbourne, FL 32940-2240 | 2005-12-07 |
| 1205817053 | Aldino G Cellini | Internal Medicine | 1600 Sarno Rd Ste 21, Melbourne, FL 32935-4992 | 2005-11-09 |
| 1417938382 | Lewis C Bean | Internal Medicine | 1600 W Eau Gallie Blvd Suite 102, Melbourne, FL 32935 | 2005-11-08 |
| 1225030513 | Darlene Go Popat | Internal Medicine | 240 N Wickham Rd Ste 202, Melbourne, FL 32935-8660 | 2005-06-01 |
| 1104829050 | Kevin B Chapin | Internal Medicine | 1314 Pine St, Melbourne, FL 32901-3117 | 2005-05-24 |
| 1164972782 | Space Coast Medical Associates Pa | Internal Medicine | 1600 Sarno Rd Ste 21, Melbourne, FL 32935-4992 | 2016-10-06 |
| 1053681924 | Institute for Health Care, LLC | Internal Medicine | 930 S Harbor City Blvd, 100, Melbourne, FL 32901-1963 | 2012-01-09 |
| 1962717058 | Melbourne Hma Medical Group, LLC | Internal Medicine | 8055 Spyglass Hill Rd, Melbourne, FL 32940-8564 | 2010-08-12 |
| Find all providers in MELBOURNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.