Provider Demographics
NPI:1316042831
Name:MERENDINO, JOHN JEROME JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JEROME
Last Name:MERENDINO
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:10215 FERNWOOD RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1106
Mailing Address - Country:US
Mailing Address - Phone:301-230-0300
Mailing Address - Fax:301-230-0314
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:SUITE 405
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1106
Practice Address - Country:US
Practice Address - Phone:301-230-0300
Practice Address - Fax:301-230-0314
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2016-03-30
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Provider Licenses
StateLicense IDTaxonomies
MDD36046207RE0101X
FLME71106207RE0101X
MED0036046207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD218651900Medicaid
MD218651900Medicaid
MDF10495Medicare UPIN