Provider Demographics
NPI:1972587491
Name:MANDELL, BARRY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:ALAN
Last Name:MANDELL
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 1:397 LITTLE NECK RD
Mailing Address - Street 2:3300 SOUTH BLDG STE. 202
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5765
Mailing Address - Country:US
Mailing Address - Phone:757-227-4300
Mailing Address - Fax:757-486-3125
Practice Address - Street 1:397 LITTLE NECK RD
Practice Address - Street 2:3300 SOUTH BLDG STE. 202
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5765
Practice Address - Country:US
Practice Address - Phone:757-227-4300
Practice Address - Fax:757-486-3125
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101057334207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA12133OtherOPTIMA
VACN4826OtherMEDICARE RAILROAD
VA243434OtherANTHEM
VADF9144OtherMEDICARE RAILROAD
VA006305555Medicaid
VA006305555Medicaid
VACN4826OtherMEDICARE RAILROAD