Mandal'S Conservative Nephrology Practice, LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

ME0074439 Issued in FL

Legal business name

MANDAL'S CONSERVATIVE NEPHROLOGY PRACTICE, LLC

Practice address

800 Zeagler Dr
Palatka, FL 32177-3883

Phone

(904) 824-8158

NPI assigned

Mar 17, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Anil Kumar Mandal, M.D.

Title

Owner

Phone

(904) 305-1234

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458172800000",
    "number": "1376904417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 ZEAGLER DR",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321773883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ZEAGLER DR",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321773883",
            "telephone_number": "904-824-8158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDAL'S CONSERVATIVE NEPHROLOGY PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-17",
        "last_updated": "2016-03-17",
        "status": "A",
        "authorized_official_last_name": "MANDAL",
        "authorized_official_first_name": "ANIL",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-305-1234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME0074439",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255413500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melvin Lopez, DMD
• Leamarie Lord, FNP
• Patricia Louro, PHARMD
• James H. Lynam
• Larisa Malykh, MD
• Debra Mann, APRN, PMHNP-BC
• Cheryl J Marie, M.A.
• Linnzi Marks, MA, BCBA
• Antonio M Marlow
• Natalia Lynn Marquez, PTA

• Nephrology Physician in Palatka, FL
• Providers in Palatka, FL by specialty
• Nephrology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.