Provider Demographics
NPI:1588618128
Name:JEFFREY B. MENDEL, MD, PC
Entity Type:Organization
Organization Name:JEFFREY B. MENDEL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-789-3000
Mailing Address - Street 1:PO BOX 7001
Mailing Address - Street 2:THE DIAGNOSTIC CENTER
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7001
Mailing Address - Country:US
Mailing Address - Phone:617-868-9191
Mailing Address - Fax:
Practice Address - Street 1:799 CONCORD AVE
Practice Address - Street 2:THE DIAGNOSTIC CENTER
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1048
Practice Address - Country:US
Practice Address - Phone:617-868-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM14698Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER