Provider Demographics
NPI:1790020295
Name:DEBORAH S. MENDELSON, MD PLC
Entity Type:Organization
Organization Name:DEBORAH S. MENDELSON, MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-944-4626
Mailing Address - Street 1:111 E DUNLAP AVE
Mailing Address - Street 2:#1-471
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2807
Mailing Address - Country:US
Mailing Address - Phone:602-944-4626
Mailing Address - Fax:602-396-5800
Practice Address - Street 1:9327 N 3RD ST
Practice Address - Street 2:STE 206
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2470
Practice Address - Country:US
Practice Address - Phone:602-944-4626
Practice Address - Fax:602-396-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty