Provider Demographics
NPI:1184730004
Name:MANDEL, DAVID M (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:MANDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:807 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8426
Practice Address - Country:US
Practice Address - Phone:904-390-3731
Practice Address - Fax:904-390-3429
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME73473207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1414107Medicaid
FL252624700Medicaid
GA000752727AMedicaid
GA000752727AMedicaid
G64748Medicare UPIN