1043425267 NPI number — ALEX MANDEL, M.D.

Table of content: (NPI 1043425267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043425267 NPI number — ALEX MANDEL, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEX MANDEL, M.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043425267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 MASSASOIT AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
EAST PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02914-2012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-434-8226
Provider Business Mailing Address Fax Number:
401-434-4178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 MASSASOIT AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02914-2012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-434-8226
Provider Business Practice Location Address Fax Number:
401-434-4178
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MANDEL
Authorized Official First Name:
ALEX
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
401-434-8226

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD05393 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001401 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7005442 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: M16447 . This is a "BLUE SHIELD OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: B10041001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: C22019 . This is a "BLUE SHIELD OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 977-3 . This is a "BLUE SHIELD OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 5393 . This is a "LIFESPAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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