Provider Demographics
NPI:1275714149
Name:DR. CHARLES MANDEL O.D., P.C.
Entity Type:Organization
Organization Name:DR. CHARLES MANDEL O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:I
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:413-442-6991
Mailing Address - Street 1:37 CHESHIRE RD
Mailing Address - Street 2:ALLENDALE SHOPPING CENTER
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-1831
Mailing Address - Country:US
Mailing Address - Phone:413-442-6991
Mailing Address - Fax:413-443-4205
Practice Address - Street 1:37 CHESHIRE RD
Practice Address - Street 2:ALLENDALE SHOPPING CENTER
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-1831
Practice Address - Country:US
Practice Address - Phone:413-442-6991
Practice Address - Fax:413-443-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2430261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA14122OtherHNE
MA0332208Medicaid
W15568OtherBCBS
MA161058Medicare PIN
W15568OtherBCBS
MA14122OtherHNE