Provider Demographics
NPI:1326029166
Name:MENDEL, JEFFREY BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:MENDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 OTIS STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2524
Mailing Address - Country:US
Mailing Address - Phone:800-927-0002
Mailing Address - Fax:
Practice Address - Street 1:180 OTIS STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2524
Practice Address - Country:US
Practice Address - Phone:617-237-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50755174400000X
RI131602085R0202X
NH147692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJM80923Medicaid
RIJ0115302OtherMEDICARE TTAN
MAJ01153Medicaid
RIJM80923Medicaid
MAJ01153Medicaid