Basic Information
| Provider Information | |||||||||
| NPI: | 1952372146 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANDEL | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4520 MIARFIELD ARC | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233214278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576386501 | ||||||||
| FaxNumber: | 7576386502 | ||||||||
| Practice Location | |||||||||
| Address1: | 1279 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235112406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574449114 | ||||||||
| FaxNumber: | 7574444720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101033513 | VA | X | Allopathic & Osteopathic Physicians | Internal Medicine | 2083A0100X | 0101033513 | VA | X | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine |
No ID Information.