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Individual
MARK G MANDABACH
Active
Individual
MARK G MANDABACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
20064
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000037019
BLUE CROSS
AL
05
—
000037019
—
AL
01
—
00117432
MISSISSIPPI MEDICAID
MS
05
—
009940371
—
AL
01
—
010033CG35508
SECTION 1011
AL
01
—
050045414
RAILROAD MEDICARE
AL
01
—
051511202
BLUE CROSS
AL
01
—
051511203
BLUE CROSS
AL
01
—
051538257
BCBS
AL
01
—
G35508
VIVA
AL
Enumeration date
07/01/2006
Last updated
06/14/2011
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