Individual
RICHARD J. MENDIETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5371
(740) 446-5711
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 441-1949
(740) 446-5982
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
19317
WV
208000000X
Pediatrics Physician
Primary
35-07-2682
OH
208000000X
Pediatrics Physician
35.072682
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000007410
ANTHEM BCBS
—
01
—
000000181967
UNISON MEDICAID
OH
01
—
001714096
MOUNTAIN STATE BCBS
—
05
—
0111033000
—
WV
01
—
2037718
MOLINA MEDICAID
OH
01
—
310917085028
CARESOURCE MEDICAID
OH
01
—
370008914
RR MEDICARE
—
Enumeration date
05/30/2006
Last updated
11/04/2020
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