Healthcare Provider Details

I. General information

NPI: 1760661854
Provider Name (Legal Business Name): JEFFREY VARYCK MENDELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 THOMAS JOHNSON DR SUITE 200
FREDERICK MD
21702-4354
US

IV. Provider business mailing address

PO BOX 1745 SUITE 200
CUMBERLAND MD
21501-1745
US

V. Phone/Fax

Practice location:
  • Phone: 301-695-8390
  • Fax:
Mailing address:
  • Phone: 301-759-5280
  • Fax: 301-777-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD36477
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: