Provider Demographics
NPI:1851396600
Name:MENDELSON, LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:MENDELSON
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 1:825 OLD LANCASTER RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3231
Mailing Address - Country:US
Mailing Address - Phone:610-527-1165
Mailing Address - Fax:610-527-6611
Practice Address - Street 1:825 OLD LANCASTER RD
Practice Address - Street 2:SUITE 320
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3231
Practice Address - Country:US
Practice Address - Phone:610-527-1165
Practice Address - Fax:610-527-6611
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047626L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016237730012Medicaid
PA0016237730007Medicaid
PA740071F7EMedicare ID - Type UnspecifiedMEDICARE
PA740071EGWMedicare PIN
PA0016237730012Medicaid