Provider Demographics
NPI:1689771024
Name:RICHARD S MENDELSOHN
Entity Type:Organization
Organization Name:RICHARD S MENDELSOHN
Other - Org Name:FAMILY FOOT AND ANKLE CENTERS, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-273-9818
Mailing Address - Street 1:9918 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3901
Mailing Address - Country:US
Mailing Address - Phone:703-273-9818
Mailing Address - Fax:
Practice Address - Street 1:9918 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3901
Practice Address - Country:US
Practice Address - Phone:703-273-9818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA727213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1667200001Medicare NSC
VACM2201Medicare PIN
DC455604Medicare PIN