Provider Demographics
NPI:1508852492
Name:MENDELSON, DEBORAH S (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:MENDELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9327 N 3RD ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2470
Mailing Address - Country:US
Mailing Address - Phone:602-944-4626
Mailing Address - Fax:602-396-5800
Practice Address - Street 1:111 E DUNLAP AVE
Practice Address - Street 2:#1-471
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2807
Practice Address - Country:US
Practice Address - Phone:602-944-4626
Practice Address - Fax:602-396-5800
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12965207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ232934Medicaid
AZ070000807OtherRAILROAD MEDICARE
AZ070000807OtherRAILROAD MEDICARE
AZD37290Medicare UPIN
AZ275504884Medicare ID - Type Unspecified