Provider Demographics
NPI:1831295088
Name:MENDEZ-TADEL, MARIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:
Last Name:MENDEZ-TADEL
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 1:3615 HAMILTON ST
Mailing Address - Street 2:POWELTON VILLAGE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2327
Mailing Address - Country:US
Mailing Address - Phone:215-382-1110
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY AND WOODLAND AVE.
Practice Address - Street 2:VA MECICAL CENTER, MENTAL HEALTH CLINIC, 7TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-823-4038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4230142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry