Provider Demographics
NPI:1043425267
Name:ALEX MANDEL, M.D.
Entity Type:Organization
Organization Name:ALEX MANDEL, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-434-8226
Mailing Address - Street 1:400 MASSASOIT AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-2012
Mailing Address - Country:US
Mailing Address - Phone:401-434-8226
Mailing Address - Fax:401-434-4178
Practice Address - Street 1:400 MASSASOIT AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-2012
Practice Address - Country:US
Practice Address - Phone:401-434-8226
Practice Address - Fax:401-434-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI001401OtherBLUE CHIP
RI7005442Medicaid
MAM16447OtherBLUE SHIELD OF MA
B10041001OtherCIGNA
MAC22019OtherBLUE SHIELD OF MA
RI977-3OtherBLUE SHIELD OF RI
RI5393OtherLIFESPAN
RI7005442Medicaid
RI977-3OtherBLUE SHIELD OF RI
MAM16447OtherBLUE SHIELD OF MA