Healthcare Provider Details

I. General information

NPI: 1649561515
Provider Name (Legal Business Name): MATTHEW THOMAS MANTELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MEDICAL CIR
WINCHESTER VA
22601-3322
US

IV. Provider business mailing address

128 MEDICAL CIRCLE
WINCHESTER VA
22601-3322
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-8975
  • Fax:
Mailing address:
  • Phone: 540-667-8975
  • Fax: 540-667-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101262349
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number0101262349
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: