Physician Compare National (NPI:1912902545)

HEALTHCARE PROVIDER: JENNIFER E MULLENDORE DPM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1912902545
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1658393939
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20051230000032
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MULLENDORE
	Individual professional last name
Provider First Name	JENNIFER
	Individual professional first name
Provider Middle Name	ERIN
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	DPM
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	TEMPLE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	LASER PODIATRY ASSOCIATES, LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	0345409181
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1001 TWIN ARCH RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B3
	Group Practice or individual's line 2 address
City	MOUNT AIRY
	Group Practice or individual's city
State	MD
	Group Practice or individual's state
Zip Code	217714138
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3018295111
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	210005
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	FREDERICK MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y