Provider Demographics
NPI:1104800226
Name:MERENDINO, ANTONY (DPM)
Entity type:Individual
Prefix:DR
First Name:ANTONY
Middle Name:
Last Name:MERENDINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 HULL RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4144
Mailing Address - Country:US
Mailing Address - Phone:352-273-7394
Mailing Address - Fax:352-273-7395
Practice Address - Street 1:3450 HULL RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-273-7394
Practice Address - Fax:352-273-7395
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD1035213E00000X
TNDPM0000000651213E00000X
FLPO2511213E00000X
FLPO4108213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390291900Medicaid
FL65418Medicare ID - Type Unspecified
TNU59335Medicare UPIN
FLU59335Medicare UPIN