Provider Demographics
NPI:1770541294
Name:MANDEL, MARK RICHARD (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:RICHARD
Last Name:MANDEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22634 SECOND STREET
Mailing Address - Street 2:STE 101
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541
Mailing Address - Country:US
Mailing Address - Phone:510-886-5497
Mailing Address - Fax:510-886-4465
Practice Address - Street 1:1237 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:510-886-3937
Practice Address - Fax:510-886-6304
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00G424180207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48953Medicare UPIN
CA180013411Medicare PIN