Provider Demographics
NPI:1790705531
Name:MANDPE, ADITI H (MD)
Entity Type:Individual
Prefix:
First Name:ADITI
Middle Name:H
Last Name:MANDPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 CALIFORNIA ST RM 505
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1507
Mailing Address - Country:US
Mailing Address - Phone:415-751-4914
Mailing Address - Fax:415-751-1414
Practice Address - Street 1:3838 CALIFORNIA ST RM 505
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1507
Practice Address - Country:US
Practice Address - Phone:415-751-4914
Practice Address - Fax:415-751-1414
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78083207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G780831Medicare ID - Type Unspecified
G50106Medicare UPIN