Basic Information
Provider Information
NPI: 1700828654
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MENDELSON
FirstName: NEIL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 901 W BEN WHITE BLVD
Address2:  
City: AUSTIN
State: TX
PostalCode: 787046903
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 901 W BEN WHITE BLVD
Address2:  
City: AUSTIN
State: TX
PostalCode: 787046903
CountryCode: US
TelephoneNumber: 5124472211
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/12/2006
LastUpdateDate: 05/18/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207PE0004XK6149TXN Allopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
207P00000XK6149TXY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


Home