Provider Demographics
NPI:1699873992
Name:MANDEL, WILLIAM SCOTT (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SCOTT
Last Name:MANDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:MANDEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704-0202
Mailing Address - Country:US
Mailing Address - Phone:808-323-8200
Mailing Address - Fax:808-323-8400
Practice Address - Street 1:82-6123 MAMALAHOA HWY
Practice Address - Street 2:TOP FLOOR
Practice Address - City:CAPTAIN COOK
Practice Address - State:HI
Practice Address - Zip Code:96704-8203
Practice Address - Country:US
Practice Address - Phone:808-323-8200
Practice Address - Fax:808-323-8400
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3644208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01159301Medicaid
HIC1212-4OtherHMSA PROVIDER NUMBER
HIAM6960202OtherDEA REGISTRATION #
HIEO1184Medicare UPIN
HI56348Medicare ID - Type Unspecified