Provider Demographics
NPI:1114389152
Name:MANDAS, VINCENT HARALAMBOS (DPM,)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:HARALAMBOS
Last Name:MANDAS
Suffix:
Gender:M
Credentials:DPM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-0527
Mailing Address - Country:US
Mailing Address - Phone:614-788-5000
Mailing Address - Fax:614-788-5100
Practice Address - Street 1:303 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4601
Practice Address - Country:US
Practice Address - Phone:614-788-5000
Practice Address - Fax:614-788-5100
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH36.003933213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty