Individual
MS. MARY BETH LENNOX MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
410 MALCOLM DR, SUITE A, WESTMINSTER, MD 21157-6160
(410) 876-1633
(410) 840-2100
Mailing address
25 CROSSROADS DR STE 306, ATTN: CREDENTIALING, OWINGS MILLS, MD 21117-5437
(443) 738-2872
(443) 738-2713
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
C01911
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970005976
R/R MEDICARE PROVIDER #
MD
01
—
CN6601
R/R MEDICARE GROUP #
MD
01
—
P00250839
R/R MEDICARE PROVIDER #
MD
Enumeration date
03/29/2006
Last updated
04/29/2014
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