MEDICARE: DAVID R. MANDEL MD INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	35042685M	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508050915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID R. MANDEL MD INC.

Provider Business Mailing Address
First Line	:	6551 WILSON MILLS RD
Second Line	:	SUITE 106
City	:	CLEVELAND
State	:	OH
Zip	:	44143-3495
Country	:	US
Telephone Number	:	440-449-8277
Fax Number	:	440-449-7137

Provider Business Practice Location Address
First Line	:	6551 WILSON MILLS RD
Second Line	:	SUITE 106
City	:	CLEVELAND
State	:	OH
Zip	:	44143-3495
Country	:	US
Telephone Number	:	440-449-8277
Fax Number	:	440-449-7137

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DAVID M ROTHHAAS
Credential	:
Telephone Number	:	440-449-8277

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	01/24/2020

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