Individual
DOREEN PEREZ MONDELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 PATROON CREEK BLVD STE 100, ALBANY, NY 12206-5014
(518) 618-1100
Mailing address
PO BOX 14890, ALBANY, NY 12212-4890
(518) 525-5634
(518) 649-4094
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
265445
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03464019
—
NY
01
—
120821000140
FIDELIS
NY
01
—
187YS1
EMPIRE BCBS
NY
01
—
9635885
AETNA
NY
Enumeration date
09/02/2010
Last updated
05/14/2021
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