Provider Demographics
NPI:1992024012
Name:ELIZABETH MANDELL MD PLC
Entity Type:Organization
Organization Name:ELIZABETH MANDELL MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:MANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-249-1613
Mailing Address - Street 1:280 TURKEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-9727
Mailing Address - Country:US
Mailing Address - Phone:434-249-1613
Mailing Address - Fax:888-484-0060
Practice Address - Street 1:325 FOUR LEAF LN
Practice Address - Street 2:SUITE 11-B
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-9203
Practice Address - Country:US
Practice Address - Phone:434-249-1613
Practice Address - Fax:888-484-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047968207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty