Provider Demographics
NPI:1649238395
Name:MANDEL, MARTIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:L
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 1:36100 EUCLID AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4456
Mailing Address - Country:US
Mailing Address - Phone:440-951-1073
Mailing Address - Fax:440-951-1844
Practice Address - Street 1:36100 EUCLID AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4456
Practice Address - Country:US
Practice Address - Phone:440-951-1073
Practice Address - Fax:440-951-1844
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist