Provider Demographics
NPI:1891889341
Name:MENDELSON, JOHN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:MENDELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:909 HYDE ST
Mailing Address - Street 2:210
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4822
Mailing Address - Country:US
Mailing Address - Phone:415-474-7900
Mailing Address - Fax:415-474-7930
Practice Address - Street 1:909 HYDE ST
Practice Address - Street 2:210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4822
Practice Address - Country:US
Practice Address - Phone:415-474-7900
Practice Address - Fax:415-474-7930
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG49959207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG49959Medicaid
CAA51519Medicare UPIN