Provider Demographics
NPI:1306893664
Name:MANDAL, SANAT KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SANAT
Middle Name:KUMAR
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 1:829 SPRUCE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5752
Mailing Address - Country:US
Mailing Address - Phone:215-829-3530
Mailing Address - Fax:215-829-3090
Practice Address - Street 1:829 SPRUCE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5752
Practice Address - Country:US
Practice Address - Phone:215-829-3530
Practice Address - Fax:215-829-3090
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034154L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007909550001Medicaid
PA007909550001Medicaid
PA130356Medicare ID - Type UnspecifiedMEDICARE