Provider Demographics
NPI:1295101590
Name:PETER MENDELSOHN M D INC
Entity type:Organization
Organization Name:PETER MENDELSOHN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-560-8806
Mailing Address - Street 1:5456 VALLEY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2231
Mailing Address - Country:US
Mailing Address - Phone:323-296-8671
Mailing Address - Fax:323-296-8673
Practice Address - Street 1:120 S SPALDING DR
Practice Address - Street 2:SUITE 315
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1800
Practice Address - Country:US
Practice Address - Phone:310-560-8806
Practice Address - Fax:323-296-8673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65308207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty