Active NPI
Michael Anthony Mandella, MA LIC 99
- Specialist
- Lunenburg, MA
National Provider Identifier
1285272559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA99
- Practice address
- 615 Reservoir Rd
Lunenburg, MA 01462-1540 - Phone
- (978) 771-7582
- Fax
- (978) 582-8264
- NPI assigned
- Dec 17, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA99 | MA | Primary |
Addresses
Primary practice location
615 Reservoir Rd
Lunenburg, MA 01462-1540
Mailing address
615 Reservoir Rd
Lunenburg, MA 01462-1540
Phone (978) 771-7582
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA99 | MA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576540800000",
"number": "1285272559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 RESERVOIR RD",
"city": "LUNENBURG",
"state": "MA",
"postal_code": "014621540",
"telephone_number": "978-771-7582",
"fax_number": "978-582-8264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 RESERVOIR RD",
"city": "LUNENBURG",
"state": "MA",
"postal_code": "014621540",
"telephone_number": "978-771-7582",
"fax_number": "978-582-8264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDELLA",
"first_name": "MICHAEL",
"middle_name": "ANTHONY",
"name_prefix": "Mr.",
"credential": "MA LIC 99",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-12-17",
"last_updated": "2019-12-17",
"certification_date": "2019-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "MA",
"license": "MA99",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lunenburg, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.