Provider Demographics
NPI:1912904988
Name:MENDES, MANUELA (MD)
Entity type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:MENDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 PLEASANT ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3005
Mailing Address - Country:US
Mailing Address - Phone:508-679-1033
Mailing Address - Fax:
Practice Address - Street 1:289 PLEASANT ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3005
Practice Address - Country:US
Practice Address - Phone:508-679-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F67610Medicare UPIN
MABX6900Medicare PIN
J30137Medicare PIN