Provider Demographics
NPI:1336477025
Name:MENDELSSOHN, MARTIN G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:G
Last Name:MENDELSSOHN
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 1:3801 NE 207TH ST
Mailing Address - Street 2:APT 2201
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4703
Mailing Address - Country:US
Mailing Address - Phone:305-931-9876
Mailing Address - Fax:
Practice Address - Street 1:21150 BISCAYNE BLVD
Practice Address - Street 2:STE 104
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1226
Practice Address - Country:US
Practice Address - Phone:954-431-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 021345207X00000X
TXTM 00182207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery