Provider Demographics
NPI:1053776120
Name:PHILIP G. MONDI, M.D., P.A.
Entity type:Organization
Organization Name:PHILIP G. MONDI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:MONDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-235-3195
Mailing Address - Street 1:80 AVIEMORE CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9732
Mailing Address - Country:US
Mailing Address - Phone:910-235-3195
Mailing Address - Fax:910-235-3431
Practice Address - Street 1:80 AVIEMORE CT
Practice Address - Street 2:SUITE C
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9732
Practice Address - Country:US
Practice Address - Phone:910-235-3195
Practice Address - Fax:910-235-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601769305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization