Provider Demographics
NPI:1427030170
Name:MANDEL, RACHEL I (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:I
Last Name:MANDEL
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 1:75 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4895
Mailing Address - Country:US
Mailing Address - Phone:301-620-0010
Mailing Address - Fax:301-682-3977
Practice Address - Street 1:75 THOMAS JOHNSON DRIVE
Practice Address - Street 2:SUITE J
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4895
Practice Address - Country:US
Practice Address - Phone:301-620-0010
Practice Address - Fax:301-682-3977
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047236207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15050Medicaid
MD994LM426Medicare PIN
MD15050Medicaid
MDG02918Medicare UPIN