Healthcare Provider Details

I. General information

NPI: 1841309903
Provider Name (Legal Business Name): JESSICA KAISER MENDELSOHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA N. KAISER MD

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 RIVERCHASE BLVD SUITE 2400
ROCK HILL SC
29732-2084
US

IV. Provider business mailing address

PO BOX 602120
CHARLOTTE NC
28260-2120
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-5131
  • Fax: 803-366-3300
Mailing address:
  • Phone: 803-329-5131
  • Fax: 803-366-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200500211
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: