Provider Demographics
NPI:1063578995
Name:MEZHERITSKIY, IRINA S (MD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:S
Last Name:MEZHERITSKIY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-2400
Mailing Address - Country:US
Mailing Address - Phone:321-434-4600
Mailing Address - Fax:321-259-0635
Practice Address - Street 1:1350 S HICKORY ST
Practice Address - Street 2:HOLMES REGIONAL MEDICAL CENTER/RADIOLOGY
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-7313
Practice Address - Fax:321-434-7238
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2013-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT1887132085R0202X
FLME1064222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002305000Medicaid
FLDH800ZMedicare PIN