Provider Demographics
NPI:1770731812
Name:TADELE, MAHLET (MD)
Entity type:Individual
Prefix:
First Name:MAHLET
Middle Name:
Last Name:TADELE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 PACKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1616
Mailing Address - Country:US
Mailing Address - Phone:917-693-2243
Mailing Address - Fax:
Practice Address - Street 1:3424 KOSSUTH AVE
Practice Address - Street 2:NORTH CENTRAL BRONX HOSPITAL, 10A 18
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-519-4951
Practice Address - Fax:718-519-5077
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY247770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine