Provider Demographics
NPI:1942272240
Name:MANDELL, MARK H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:MANDELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:72 HIGHLAND AVE
Mailing Address - Street 2:PEDIATRIC ASSOCIATES OF GREATER SALEM
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-745-3050
Mailing Address - Fax:978-744-9594
Practice Address - Street 1:72 HIGHLAND AVE
Practice Address - Street 2:PEDIATRIC ASSOCIATES OF GREATER SALEM
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-745-3050
Practice Address - Fax:978-744-9594
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA50826208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2091321Medicaid
050827OtherTUFTS
J02433OtherBCBS
MAJ02433Medicare ID - Type Unspecified
MA2091321Medicaid