Provider Demographics
NPI:1508050915
Name:DAVID R. MANDEL MD INC.
Entity Type:Organization
Organization Name:DAVID R. MANDEL MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROTHHAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-449-8277
Mailing Address - Street 1:6551 WILSON MILLS RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3495
Mailing Address - Country:US
Mailing Address - Phone:440-449-8277
Mailing Address - Fax:440-449-7137
Practice Address - Street 1:6551 WILSON MILLS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44143-3495
Practice Address - Country:US
Practice Address - Phone:440-449-8277
Practice Address - Fax:440-449-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042685M207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0457269Medicaid
OH9306151Medicare PIN
OHB95442Medicare UPIN
OH0454637Medicare PIN
OH9306152Medicare PIN
OH0454638Medicare PIN