Basic Information
| Provider Information | |||||||||
| NPI: | 1770043374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENDELSOHN | ||||||||
| FirstName: | JAYME | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3737 MARKET ST | ||||||||
| Address2: | FL 9 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191045545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156628777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 BOSTON MEDICAL CENTER PLACE | ||||||||
| Address2: | DOWLING 5TH FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174144465 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2019 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MT218582 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 291559 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.