Provider Demographics
NPI:1114971736
Name:JOSHI, MANDAR V (MD)
Entity Type:Individual
Prefix:
First Name:MANDAR
Middle Name:V
Last Name:JOSHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W RANDOL MILL RD
Mailing Address - Street 2:ARLINGTON CANCER CENTER
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2510
Mailing Address - Country:US
Mailing Address - Phone:817-261-4906
Mailing Address - Fax:817-543-4675
Practice Address - Street 1:906 W RANDOL MILL RD
Practice Address - Street 2:ARLINGTON CANCER CENTER
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2510
Practice Address - Country:US
Practice Address - Phone:817-261-4906
Practice Address - Fax:817-543-4675
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM07712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176287407Medicaid
TX176287405Medicaid
TX176287406Medicaid
TX176287407Medicaid
TX8L23442Medicare PIN
TX176287405Medicaid
TX8L23440Medicare PIN