Provider Demographics
NPI:1225113178
Name:MANDEL, LLOYD BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:BERNARD
Last Name:MANDEL
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 1:588 OLD MOUNT HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2814
Mailing Address - Country:US
Mailing Address - Phone:843-376-5595
Mailing Address - Fax:843-797-7432
Practice Address - Street 1:588 OLD MOUNT HOLLY RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2814
Practice Address - Country:US
Practice Address - Phone:843-376-5595
Practice Address - Fax:843-797-7432
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10054208VP0000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0504Medicaid
SCB831Medicare UPIN
SCC60180Medicare UPIN