Provider Demographics
NPI:1568956530
Name:MANDLEBAUM, INSUN CHOI (NP)
Entity Type:Individual
Prefix:MS
First Name:INSUN
Middle Name:CHOI
Last Name:MANDLEBAUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12253 TILDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4161
Mailing Address - Country:US
Mailing Address - Phone:248-892-2310
Mailing Address - Fax:
Practice Address - Street 1:12253 TILDENWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4161
Practice Address - Country:US
Practice Address - Phone:248-892-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF06181864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily