Provider Demographics
NPI:1376559278
Name:MUCH, MANDELL J (DO)
Entity Type:Individual
Prefix:DR
First Name:MANDELL
Middle Name:J
Last Name:MUCH
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 1:600 RED HILL RD
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-1201
Mailing Address - Country:US
Mailing Address - Phone:610-558-6447
Mailing Address - Fax:610-558-6448
Practice Address - Street 1:600 RED HILL RD
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-1201
Practice Address - Country:US
Practice Address - Phone:610-558-6447
Practice Address - Fax:610-558-6448
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002096L207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-1914684OtherTAX ID
PA23-1914684OtherTAX ID
PAB34195Medicare UPIN