Individual
MARK A MENDICINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
746 JEFFERSON AVE, SCRANTON, PA 18510-1624
(570) 346-7797
(570) 342-9802
Mailing address
3998 FAIR RIDGE DR, STE 300, FAIRFAX, VA 22033-2921
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN324534L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00804060
RR MEDICARE
PA
01
—
P00952233
RR MEDICARE
PA
Enumeration date
08/11/2009
Last updated
03/19/2015
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