Provider Demographics
NPI:1982279931
Name:MANDAL, SANDEEP (MD)
Entity Type:Individual
Prefix:MR
First Name:SANDEEP
Middle Name:
Last Name:MANDAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SOUTH WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505
Mailing Address - Country:US
Mailing Address - Phone:570-591-5175
Mailing Address - Fax:
Practice Address - Street 1:501 SOUTH WASHINGTON AVE.
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505
Practice Address - Country:US
Practice Address - Phone:570-591-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2023-08-16
Deactivation Date:2022-11-14
Deactivation Code:
Reactivation Date:2023-08-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program