Provider Demographics
NPI:1598858680
Name:MANDEL, COREY S (MD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:S
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-2140
Practice Address - Fax:817-332-2506
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL70302080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherBCBSTX GRP PIN
TX7766514OtherAETNA PIN
TX8F3702OtherBCBSTX IND PIN
TX134555100OtherFIRSTCARE PIN
TX140442852Medicaid
TX160589102Medicaid
TX160589104Medicaid
TX10011072OtherAMERIGROUP PIN
TX137345810Medicaid
1750369203OtherGRP NPI NUMBER
TX124150OtherSUPERIOR PIN
TX2151026OtherCIGNA PIN
TX2146007OtherFIRSTHEALTH PIN
TX2341182OtherUHC PIN
TX8F3702OtherBCBSTX IND PIN
1750369203OtherGRP NPI NUMBER
TX160589102Medicaid