Provider Demographics
NPI:1396021929
Name:MANDADI, SUBHADRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBHADRA
Middle Name:
Last Name:MANDADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3100 MACCORKLE AVE SE STE 902
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1234
Mailing Address - Country:US
Mailing Address - Phone:304-388-6590
Mailing Address - Fax:304-388-6595
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 902
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1234
Practice Address - Country:US
Practice Address - Phone:304-388-6590
Practice Address - Fax:304-388-6595
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV27497207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease