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General NPI Number Information
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NPI Number | 1104984046
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Entity Type | Individual
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Provider Name | MARK MANTELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 51 N. 39TH STREET HEART & VASCULAR PAVILION 4TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2640
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Country | US
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Telephone | 215-662-9551
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Fax | 215-243-3225
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Provider Business Mailing Address
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Address Line | PO BOX 416147
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City | BOSTON
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State | MA
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Zip | 02241-6147
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Country | US
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Telephone | 610-644-8900
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Fax | 484-924-0053
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD047966L
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License Number State | PA
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