Provider Demographics
NPI:1174516819
Name:MENDELSOHN, RICHARD SCOTT (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
Last Name:MENDELSOHN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 825159
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5159
Mailing Address - Country:US
Mailing Address - Phone:703-273-9818
Mailing Address - Fax:866-453-6775
Practice Address - Street 1:3020 HAMAKER CT STE 201
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2220
Practice Address - Country:US
Practice Address - Phone:703-273-9818
Practice Address - Fax:703-832-8307
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA727213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009302492Medicaid
VA009302492Medicaid
DC410823F04Medicare PIN
VA1667200001Medicare NSC
VA480003866Medicare PIN