Healthcare Provider Details

I. General information

NPI: 1427030170
Provider Name (Legal Business Name): RACHEL I MANDEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 THOMAS JOHNSON DRIVE SUITE J
FREDERICK MD
21702-4895
US

IV. Provider business mailing address

75 THOMAS JOHNSON DRIVE SUITE J
FREDERICK MD
21702-4895
US

V. Phone/Fax

Practice location:
  • Phone: 301-620-0010
  • Fax: 301-682-3977
Mailing address:
  • Phone: 301-620-0010
  • Fax: 301-682-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0047236
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: