Healthcare Provider Details

I. General information

NPI: 1598704025
Provider Name (Legal Business Name): ALLAN E MENDELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST
NASHUA NH
03064-2716
US

IV. Provider business mailing address

46 NEWFANE RD
BEDFORD NH
03110-4844
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-0005
  • Fax:
Mailing address:
  • Phone: 603-883-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number77029
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: