Provider Demographics
NPI:1821036120
Name:MANDELSON, PETER G (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:MANDELSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SUITE 3001
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-973-9700
Practice Address - Fax:508-674-7378
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-04-22
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Provider Licenses
StateLicense IDTaxonomies
MA59233207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPM08447Medicaid
MA110045550AMedicaid
RIPM08447Medicaid
MAMA0014690OtherTRICARE
MA2501004OtherUNITED HEALTH CARE
RI46361OtherRI BLUE SHIELD
RIPM08447OtherEDS
MA000000022174OtherBMC HEALTHNET
MA0003573OtherNEIGHBORHOOD HEALTH
MA531612OtherAETNA US HEALTHCARE
MA6637OtherHARVARD PILGRIM
MA3033180Medicaid
MAB74937Medicare UPIN
MA059233OtherTUFTS HEALTH PLAN
MA060016808OtherPALMETTO GBA