Kenneth D Mandl, MD, MPH

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

75410 Issued in MA

Practice address

300 Longwood Ave
Children'S Hospital Boston
Boston, MA 02115-5735

Phone

(617) 355-6624

Fax

(617) 730-0335

NPI assigned

Aug 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187222400000",
    "number": "1396852406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "address_2": "CHILDREN'S HOSPITAL BOSTON-DIVISION OF EMERGENCY MED",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155737",
            "telephone_number": "617-355-6624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "address_2": "CHILDREN'S HOSPITAL BOSTON",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155735",
            "telephone_number": "617-355-6624",
            "fax_number": "617-730-0335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDL",
        "first_name": "KENNETH",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2007-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "75410",
            "primary": true
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "MA",
            "license": "75410",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3107180",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emma Manderville
• Eva Mandes, DMD
• Edwin M Mandieka, MD
• Chelsea Anne Mandigo, MS, LCGC
• Hanna Katrina Mandl
• Aida Manduley Escribano, MSW, LCSW
• Vasudev C Mandyam, MD
• Ethan Manelin, MD
• Celeste Maness
• William L. Maness, DDS

• Pediatrics Physician in Boston, MA
• Providers in Boston, MA by specialty
• Pediatrics Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; 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.