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General NPI Number Information
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NPI Number | 1558378992
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Entity Type | Individual
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Provider Name | ROGER B MENDELSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 3036 REGENT ST
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City | BERKELEY
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State | CA
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Zip | 94705-2551
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Country | US
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Telephone | 510-206-1213
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Fax | 510-849-2219
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Provider Business Mailing Address
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Address Line | 3036 REGENT ST
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City | BERKELEY
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State | CA
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Zip | 94705-2551
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Country | US
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Telephone | 510-206-1213
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Fax | 510-849-2219
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A22911
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License Number State | CA
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