Provider Demographics
NPI:1366420077
Name:MANDELL, JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MANDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:CHILDREN'S UROLOGICAL FOUNDATION
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-8338
Mailing Address - Fax:617-730-0474
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:CHILDREN'S UROLOGICAL FOUNDATION
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-8338
Practice Address - Fax:617-730-0474
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54192208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021790OtherNHP
7500524OtherUHP
7500524OtherUNI4
P3310627OtherOXFORD
MA6193382Medicaid
705720OtherTUF
7500524OtherMETRA
B21029201OtherCIG2
7500524OtherUNI7
AA8300OtherHPHC
Z11048OtherHEALT
11273OtherHNE
705720OtherTUFTS
7500524OtherUNI1
000000009226OtherBMC
3054947OtherWCT
60617OtherFCHP
998064OtherNETHE
B21029201OtherCIG2