MEDICARE: JACQUES MENDELSOHN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	020510	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	010020510CT01	OTHER	CT	ANTHEM BLUE SHIELD
3	0V3643	OTHER		HELATHNET

General Provider Information

NPI Number	:	1861416703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUES MENDELSOHN MD

Provider Business Mailing Address
First Line	:	506 CROMWELL AVE
Second Line	:
City	:	ROCKY HILL
State	:	CT
Zip	:	06067-1851
Country	:	US
Telephone Number	:	860-529-1287
Fax Number	:	860-721-6311

Provider Business Practice Location Address
First Line	:	506 CROMWELL AVE
Second Line	:
City	:	ROCKY HILL
State	:	CT
Zip	:	06067-1851
Country	:	US
Telephone Number	:	860-529-1287
Fax Number	:	860-721-6311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	06/21/2021

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Directions to “ JACQUES MENDELSOHN MD” Practice Location

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