Provider Demographics
NPI:1013061431
Name:MANDANAS, LINDA D (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:D
Last Name:MANDANAS
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 1:144 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2552
Mailing Address - Country:US
Mailing Address - Phone:315-342-1765
Mailing Address - Fax:315-342-1742
Practice Address - Street 1:144 W 5TH ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2552
Practice Address - Country:US
Practice Address - Phone:315-342-1765
Practice Address - Fax:315-342-1742
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177012-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02270006Medicaid
C65553Medicare UPIN
NY02270006Medicaid