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NPI Code Detail

MEDICARE: ZACHARY TYLER MANDEL

MEDICARE: ZACHARY TYLER MANDEL
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1518812593
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACHARY TYLER MANDEL
Provider Business Mailing Address
First Line : 55 LAKE AVE N
Second Line :
City : WORCESTER
State : MA
Zip : 01655-0002
Country : US
Telephone Number : 855-862-7763
Fax Number : 508-856-5911
Provider Business Practice Location Address
First Line : 55 LAKE AVE N
Second Line :
City : WORCESTER
State : MA
Zip : 01655-0002
Country : US
Telephone Number : 508-334-1000
Fax Number : 508-856-5911
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2026
Last Update Date : 06/18/2026

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Directions to “ ZACHARY TYLER MANDEL ” Practice Location

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