Healthcare Provider Details

I. General information

NPI: 1558378992
Provider Name (Legal Business Name): ROGER B MENDELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3036 REGENT ST
BERKELEY CA
94705-2551
US

IV. Provider business mailing address

3036 REGENT ST
BERKELEY CA
94705-2551
US

V. Phone/Fax

Practice location:
  • Phone: 510-206-1213
  • Fax: 510-849-2219
Mailing address:
  • Phone: 510-206-1213
  • Fax: 510-849-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA22911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: