Individual
MARK G MANDABACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-6600
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
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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