Basic Information
Provider Information
NPI: 1003006800
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MENA
FirstName: BRIDGIT
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 301 SAINT PAUL PL
Address2: MEDICAL STAFF OFFICE
City: BALTIMORE
State: MD
PostalCode: 212022102
CountryCode: US
TelephoneNumber: 4106592802
FaxNumber:  
Practice Location
Address1: 301 SAINT PAUL PL
Address2: ORTHOPEDIC AND JOINT REPLACEMENT
City: BALTIMORE
State: MD
PostalCode: 212022102
CountryCode: US
TelephoneNumber: 4105392227
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/27/2007
LastUpdateDate: 04/09/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XC0003527MDY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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