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1669408696

NPI Code Detail

MEDICARE: DAVID E MANDELBAUM MD, PHD

MEDICARE: DAVID E MANDELBAUM MD, PHD

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	208000000X	Pediatrics Physician	151239	NY
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	151239	NY
3	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	MD11065	RI
4	2084N0600X	Clinical Neurophysiology Physician	MD11065	RI
5	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	64335	CT
6	2084N0600X	Clinical Neurophysiology Physician	151239	NY
7	2084P0005X	Neurodevelopmental Disabilities Physician	MD11065	RI
8	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	70147	MN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669408696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID E MANDELBAUM MD, PHD

Provider Business Mailing Address
First Line	:	237 IRVING AVE
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02906-5518
Country	:	US
Telephone Number	:	401-595-3467
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 PARK ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06504-8901
Country	:	US
Telephone Number	:	203-785-4081
Fax Number	:	203-737-7635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	03/11/2023

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Directions to “ DAVID E MANDELBAUM MD, PHD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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