Provider Demographics
NPI:1558155135
Name:MENOCAL MEDICAL SERVICES PA
Entity type:Organization
Organization Name:MENOCAL MEDICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENOCAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-215-1138
Mailing Address - Street 1:1050 KEY PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4496
Mailing Address - Country:US
Mailing Address - Phone:240-215-1138
Mailing Address - Fax:240-215-1140
Practice Address - Street 1:1001 PINE HEIGHTS AVE STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5266
Practice Address - Country:US
Practice Address - Phone:667-802-2100
Practice Address - Fax:240-215-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD532403300Medicaid