Provider Demographics
NPI:1427009927
Name:MANDELL, DELAINE M (MD)
Entity Type:Individual
Prefix:
First Name:DELAINE
Middle Name:M
Last Name:MANDELL
Suffix:
Gender:F
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:PO BOX 820137
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0137
Mailing Address - Country:US
Mailing Address - Phone:610-270-2352
Mailing Address - Fax:610-270-2358
Practice Address - Street 1:559 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4250
Practice Address - Country:US
Practice Address - Phone:484-622-0743
Practice Address - Fax:484-622-0643
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032654E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0119672701OtherAMERICHOICE (UHC MA PLAN)
PA1079948OtherKEYSTONE MERCY
PA7219219OtherCIGNA HMO/PPO
PA08722-MD032654EOtherHEALTH PARTNERS
PA300040389OtherRRM
PA0098337000OtherIBC - PC/KHPE
PA0011967270001Medicaid
PA0098337000OtherAMERICHOICE/INTERCOUNTY
PA350763OtherPHCS
PA410397OtherHIGHMARK BLUE SHIELD
PA08722-MD032654EOtherHEALTH PARTNERS
PA410397HMMMedicare ID - Type UnspecifiedHGSA