Provider Demographics
NPI:1902825839
Name:MENDELOW, GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:MENDELOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:MENDELOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:22221 MORNING GLORY TER
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4811
Mailing Address - Country:US
Mailing Address - Phone:561-391-2818
Mailing Address - Fax:561-391-0554
Practice Address - Street 1:22221 MORNING GLORY TER
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-4811
Practice Address - Country:US
Practice Address - Phone:561-391-2818
Practice Address - Fax:561-391-0554
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58449208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVADOOMedicare UPIN