MEDICARE: DR. JACQUELINE MANDELL MD

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	207W00000X	Ophthalmology Physician	25MA12211800	NJ
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	MD473650	PA
3	207W00000X	Ophthalmology Physician	MD473650	PA

General Provider Information

NPI Number	:	1548586522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE MANDELL MD

Provider Business Mailing Address
First Line	:	2200 ST LUKES BLVD STE 104
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5665
Country	:	US
Telephone Number	:	484-658-9330
Fax Number	:	484-503-1016

Provider Business Practice Location Address
First Line	:	2200 ST LUKES BLVD STE 104
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5665
Country	:	US
Telephone Number	:	484-658-9330
Fax Number	:

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	12/18/2025

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