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General NPI Number Information
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NPI Number | 1245205624
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Entity Type | Individual
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Provider Name | STEVEN MARK MANDEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 2191 9TH AVE N STE 120
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City | ST PETERSBURG
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State | FL
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Zip | 33713-7147
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Country | US
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Telephone | 727-954-6519
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Fax | 727-954-6524
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Provider Business Mailing Address
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Address Line | PO BOX 748817
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City | ATLANTA
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State | GA
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Zip | 30374-8817
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Country | US
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Telephone | 813-286-0033
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Fax | 813-282-1806
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | ME51051
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME51051
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License Number State | FL
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