Provider Demographics
NPI:1316363716
Name:MENDELSOHN, ALAN MARC (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MARC
Last Name:MENDELSOHN
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 1:628 S MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2957
Mailing Address - Country:US
Mailing Address - Phone:215-242-4403
Mailing Address - Fax:
Practice Address - Street 1:628 S MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2957
Practice Address - Country:US
Practice Address - Phone:215-242-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 07041L2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology