Active NPI
Amrutha Chandra Mandava, D.M.D.
- General Practice Dentistry
- Albany, NY
National Provider Identifier
1053370882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 042469
- Practice address
- 1662 Central Ave
Albany, NY 12205 - Phone
- (518) 452-2121
- Fax
- (518) 456-2865
- NPI assigned
- Mar 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 042469 | NY | Primary |
Addresses
Primary practice location
1662 Central Ave
Albany, NY 12205
Mailing address
1662 Central Ave
Albany, NY 12205
Phone (518) 452-2121
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 795808 | Other | NY | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042469 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251072000000",
"number": "1053370882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1662 CENTRAL AVE",
"city": "ALBANY",
"state": "NY",
"postal_code": "12205",
"telephone_number": "518-452-2121",
"fax_number": "518-456-2865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1662 CENTRAL AVE",
"city": "ALBANY",
"state": "NY",
"postal_code": "12205",
"telephone_number": "518-452-2121",
"fax_number": "518-456-2865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDAVA",
"first_name": "AMRUTHA",
"middle_name": "CHANDRA",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-21",
"last_updated": "2009-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "042469",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "795808",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albany, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.