Provider Demographics
NPI:1558369553
Name:MANDEL, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
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 1:6551 WILSON MILLS RD
Mailing Address - Street 2:#106
Mailing Address - City:MAYFIELD VILLAGE
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:#106
Practice Address - City:MAYFIELD VILLAGE
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-042685-M207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0457269Medicaid
OH0457269Medicaid