Provider Demographics
NPI:1841309903
Name:MENDELSOHN, JESSICA KAISER (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAISER
Last Name:MENDELSOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:N
Other - Last Name:KAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 602120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2120
Mailing Address - Country:US
Mailing Address - Phone:803-329-5131
Mailing Address - Fax:803-366-6600
Practice Address - Street 1:1656 RIVERCHASE BLVD
Practice Address - Street 2:SUITE 2400
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2084
Practice Address - Country:US
Practice Address - Phone:803-329-5131
Practice Address - Fax:803-366-3300
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905738Medicaid
NC1841309903Medicaid
SC375374Medicaid
SCSC52301909Medicare PIN
NCI64418Medicare UPIN
SCSC52304592Medicare PIN
NCNCP993AMedicare PIN
SC375374Medicaid