Provider Demographics
NPI:1851113211
Name:MENDLIFE MD LLC
Entity type:Organization
Organization Name:MENDLIFE MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:BRODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-418-6060
Mailing Address - Street 1:2827 SMITH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1426
Mailing Address - Country:US
Mailing Address - Phone:443-418-6060
Mailing Address - Fax:
Practice Address - Street 1:8114 SANDPIPER CIR STE 206
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5902
Practice Address - Country:US
Practice Address - Phone:443-418-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Single Specialty