Provider Demographics
NPI:1114389152
Name:MANDAS, VINCENT HARALAMBOS (DPM,)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:HARALAMBOS
Last Name:MANDAS
Suffix:
Gender:M
Credentials:DPM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 E STATE ST STE 670
Mailing Address - Street 2:MEDICAL EDUCATION DEPARTMENT
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4360
Mailing Address - Country:US
Mailing Address - Phone:614-566-9290
Mailing Address - Fax:614-566-8073
Practice Address - Street 1:285 E STATE ST STE 670
Practice Address - Street 2:MEDICAL EDUCATION DEPARTMENT
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4360
Practice Address - Country:US
Practice Address - Phone:614-566-9290
Practice Address - Fax:614-566-8073
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003933213ES0103X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty