Provider Demographics
NPI:1043219629
Name:MENDEL, PETER A (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:MENDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3401 COMMISSION CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1771
Mailing Address - Country:US
Mailing Address - Phone:703-490-6265
Mailing Address - Fax:703-490-6713
Practice Address - Street 1:3401 COMMISSION CT
Practice Address - Street 2:SUITE 201
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-1771
Practice Address - Country:US
Practice Address - Phone:703-490-6265
Practice Address - Fax:703-490-6713
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2009-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101039027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA56-4420-8Medicaid
C82310Medicare UPIN
VA080005520Medicare ID - Type Unspecified