Provider Demographics
NPI:1467639963
Name:MANDELL J. MUCH, D.O., PC
Entity Type:Organization
Organization Name:MANDELL J. MUCH, D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANDELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-558-6447
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002096L207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA056963Medicare PIN