Theodore Dungan Mandelkorn, MD

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

License

MD00010762 Issued in WA

Practice address

2553 76TH Ave SE
Mercer Island, WA 98040-2758

Phone

(206) 275-0702

NPI assigned

Dec 6, 2006

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 WA

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

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922167220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2553 76TH AVE SE",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980402758",
            "telephone_number": "206-275-0702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2553 76TH AVE SE",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980402758",
            "telephone_number": "206-275-0702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDELKORN",
        "first_name": "THEODORE",
        "middle_name": "DUNGAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "WA",
            "license": "MD00010762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Salamat Maglalang, PHARM.D.
• Liam Main
• Mak Abulhosn Podiatry Services PLLC
• Shelley M Malcolm, MS, CN
• Jill A Manasco, OT
• Nancy Mar
• Mark Germack DDS PLLC
• James C Martin, MD
• Bryan Gene Maruhashi, D.D.S.
• Corrado Rain Masciocchi, O.D.

• Developmental - Behavioral Pediatrics Physician in Mercer Island, WA
• Providers in Mercer Island, WA by specialty
• Developmental - Behavioral Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.