Provider Demographics
NPI:1457385312
Name:MANDEL, SUSAN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:MANDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 N ROBERTSON BLVD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2144
Mailing Address - Country:US
Mailing Address - Phone:310-652-4900
Mailing Address - Fax:213-772-3540
Practice Address - Street 1:150 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 222
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2144
Practice Address - Country:US
Practice Address - Phone:310-652-4900
Practice Address - Fax:310-652-4902
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG512571208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E67372Medicare UPIN
CAWG51571AMedicare ID - Type Unspecified