Healthcare Provider Details

I. General information

NPI: 1710994827
Provider Name (Legal Business Name): MARK F MENDELL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD MAP 2, SUITE 3301
NEWARK DE
19713-2072
US

IV. Provider business mailing address

200 HYGEIA DR PHYSICIAN CONTRACTING, SUITE 2502
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4370
  • Fax: 302-623-4375
Mailing address:
  • Phone: 302-623-7362
  • Fax: 302-623-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLB-0000156
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: