Provider Demographics
NPI:1285955526
Name:MENDELSOHN, JONATHAN S (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:MENDELSOHN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:360-782-3500
Mailing Address - Fax:360-782-3689
Practice Address - Street 1:19245 7TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-782-3500
Practice Address - Fax:360-830-3540
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2022-02-15
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Provider Licenses
StateLicense IDTaxonomies
WAMD60351741207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRES-000Medicare UPIN