Provider Demographics
NPI:1497736581
Name:MANDEL, ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:MANDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 TAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-2615
Mailing Address - Country:US
Mailing Address - Phone:401-434-8226
Mailing Address - Fax:401-434-4178
Practice Address - Street 1:328 TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-2615
Practice Address - Country:US
Practice Address - Phone:401-434-8226
Practice Address - Fax:401-434-4178
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID7005442Medicaid
RIB73617Medicare UPIN
RI007005442Medicare ID - Type Unspecified