Teodulo Reyes Mationg, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME 0028139 Issued in FL

Practice address

10201 Sr 52
Hudson, FL 34669

Phone

(727) 857-1818

Fax

(727) 857-1609

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528070400000",
    "number": "1386739506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14690 SPRING HILL DR STE 305",
            "city": "SPRING HILL",
            "state": "FL",
            "postal_code": "346098102",
            "telephone_number": "352-277-5348",
            "fax_number": "352-606-2857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 SR 52",
            "city": "HUDSON",
            "state": "FL",
            "postal_code": "34669",
            "telephone_number": "727-857-1818",
            "fax_number": "727-857-1609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATIONG",
        "first_name": "TEODULO",
        "middle_name": "REYES",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2018-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME 0028139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "225165",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "063426301",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE/STAYWELL",
            "identifier": "225165",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laurence J Martin, M.D.
• Sherry Ann Martin, LMT
• Sheryel Martin, M.D.
• Marydale Inc
• Mary Mathew
• Richard Matos
• Ayman Matter, PT
• Jacqueline Maughan
• Saro Harry Mazmanian, DO
• Shaghayegh Mazoury, DO

• Internal Medicine Physician in Hudson, FL
• Providers in Hudson, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.