Provider Demographics
NPI:1821055518
Name:MANDEL, ALYSON L (NP)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:L
Last Name:MANDEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 PLEASANT ST STE 501
Mailing Address - Street 2:PRIMA CARE GASTROENTEROLOGY
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3005
Mailing Address - Country:US
Mailing Address - Phone:508-679-6611
Mailing Address - Fax:508-679-1218
Practice Address - Street 1:289 PLEASANT ST STE 501
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3005
Practice Address - Country:US
Practice Address - Phone:508-679-6611
Practice Address - Fax:508-679-1218
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA198333363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q06780Medicare UPIN
NP4388Medicare PIN