Provider Demographics
NPI:1801829353
Name:SUSAN A MANDEL MD INC
Entity type:Organization
Organization Name:SUSAN A MANDEL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-652-4900
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:310-652-4902
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19404Medicare ID - Type Unspecified