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Individual

MARK J. MENDOLLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1223 GATEWAY DR, MELBOURNE, FL 32901-2607
(321) 312-3496
(321) 409-2517
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME67965
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
26824
BCBS OF FL
FL
05
378231000
FL
01
4671480
AETNA
FL
01
7905980
CIGNA
FL
01
P00768027
RR MEDICARE
FL
Enumeration date
12/16/2005
Last updated
01/02/2025
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