Provider Demographics
NPI:1003898644
Name:MANDELL, MORTON S (MD)
Entity Type:Individual
Prefix:
First Name:MORTON
Middle Name:S
Last Name:MANDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 OLD YORK RD
Mailing Address - Street 2:KLEIN BUILDING, SUITE 401
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3046
Mailing Address - Country:US
Mailing Address - Phone:215-329-0633
Mailing Address - Fax:215-329-6678
Practice Address - Street 1:5401 OLD YORK RD
Practice Address - Street 2:KLEIN BUILDING, SUITE 401
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3046
Practice Address - Country:US
Practice Address - Phone:215-329-0633
Practice Address - Fax:215-329-6678
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027327L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006543720003Medicaid
C26996Medicare UPIN
015567Medicare ID - Type Unspecified
PA015567JTQMedicare PIN
PAP00633841Medicare PIN