Provider Demographics
NPI:1982865739
Name:MANDRELLE, RAMNISH JAGDISH (MBBS, MD)
Entity Type:Individual
Prefix:DR
First Name:RAMNISH
Middle Name:JAGDISH
Last Name:MANDRELLE
Suffix:
Gender:M
Credentials:MBBS, MD
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Mailing Address - Street 1:451 SW SEDGWICK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-6447
Mailing Address - Country:US
Mailing Address - Phone:360-874-5900
Mailing Address - Fax:360-874-5959
Practice Address - Street 1:451 SW SEDGWICK RD STE 110
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6447
Practice Address - Country:US
Practice Address - Phone:360-874-5900
Practice Address - Fax:360-874-5959
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0067392207Q00000X
WAMD60063868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0252141OtherSTATE L&I
WAG8883587Medicare PIN