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General NPI Number Information
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NPI Number | 1841309903
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Entity Type | Individual
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Provider Name | JESSICA KAISER MENDELSOHN MD
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 1656 RIVERCHASE BLVD SUITE 2400
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City | ROCK HILL
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State | SC
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Zip | 29732-2084
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Country | US
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Telephone | 803-329-5131
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Fax | 803-366-3300
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Provider Business Mailing Address
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Address Line | PO BOX 602120
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City | CHARLOTTE
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State | NC
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Zip | 28260-2120
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Country | US
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Telephone | 803-329-5131
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Fax | 803-366-6600
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200500211
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License Number State | NC
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