Provider Demographics
NPI:1346271244
Name:MANDEL, RICHARD S (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:MANDEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2981 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1024
Mailing Address - Country:US
Mailing Address - Phone:215-632-4550
Mailing Address - Fax:215-632-7865
Practice Address - Street 1:2981 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1024
Practice Address - Country:US
Practice Address - Phone:215-632-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S009504L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG61594Medicare UPIN
PA003594Medicare UPIN