Healthcare Provider Details

I. General information

NPI: 1043219629
Provider Name (Legal Business Name): PETER ALLAN MENDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PETER ALLAN MENDELL MD

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 COMMISSION CT SUITE 201
WOODBRIDGE VA
22192-1771
US

IV. Provider business mailing address

3401 COMMISSION CT STE 201
WOODBRIDGE VA
22192-1771
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-6265
  • Fax: 703-490-6713
Mailing address:
  • Phone: 703-490-6265
  • Fax: 703-490-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101039027
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: