NPIMap

Organization Active NPI

Mandel Dermatology Boulder PLLC

  • Dermatology Physician
  • Boulder, CO
National Provider Identifier
1609518828
Registry record updated Apr 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MANDEL DERMATOLOGY BOULDER PLLC
Practice address
2575 Spruce St Unit C
Boulder, CO 80302-3806
Phone
(720) 741-8051
Fax
(720) 741-8720
NPI assigned
Apr 8, 2022
Last updated
Apr 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mitchell Jay Mandel, MDNPI 1710076427
Title
Managing Member
Phone
(720) 741-8051

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

2575 Spruce St Unit C
Boulder, CO 80302-3806

Mailing address

45 Northern Blvd
Greenvale, NY 11548-1346
Phone (516) 506-7546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220426002211 CO Part B Supplier - Clinic/Group Practice 2961899778 Receives reassigned benefits from 5 practitioners
Practice locations: Boulder, CO

National Provider Directory

National Provider Directory

Locations

117 S Spring St
Ste 100
Aspen, CO 81611

1840 Folsom St
Boulder, CO 80302
Phone (303) 443-1146

2575 Spruce St
Unit C
Boulder, CO 80302
Phone (720) 741-8051

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776297600000",
    "number": "1609518828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 NORTHERN BLVD",
            "city": "GREENVALE",
            "state": "NY",
            "postal_code": "115481346",
            "telephone_number": "516-506-7546",
            "fax_number": "720-306-7224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 SPRUCE ST UNIT C",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803023806",
            "telephone_number": "720-741-8051",
            "fax_number": "720-741-8720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDEL DERMATOLOGY BOULDER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-08",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A",
        "authorized_official_last_name": "MANDEL",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "720-741-8051",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.