Mark Angelo Mandak, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

LL92481 Issued in SC

Practice address

171 Ashley Ave
Charleston, SC 29425-8908

Phone

(843) 792-2300

NPI assigned

Jun 20, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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": "1718841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1629812102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 SHIRETON PL",
            "city": "ENOLA",
            "state": "PA",
            "postal_code": "170251349",
            "telephone_number": "717-810-7990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 ASHLEY AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258908",
            "telephone_number": "843-792-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDAK",
        "first_name": "MARK",
        "middle_name": "ANGELO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-20",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "LL92481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nedda Salehi Maltby, MD
• Margaret Maltese
• Lawrence Wade Manaker, MD
• May Manalo Smith, M.ED., LPC, NCC
• Nathaniel Louis Manche, MD
• Corina Manea, NP
• Andrew James Manett, M.D.
• Lynn M Manfred, M.D.
• Darian Manger, PA
• Harish Mangipudi, D.O.

• Internal Medicine Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Internal Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.