Provider Demographics
NPI:1295457687
Name:MENDELMAN, PAUL MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:MENDELMAN
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 1:838 ESPLANADA WAY
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-1015
Mailing Address - Country:US
Mailing Address - Phone:406-451-3132
Mailing Address - Fax:
Practice Address - Street 1:838 ESPLANADA WAY
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-1015
Practice Address - Country:US
Practice Address - Phone:406-451-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG295552080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty