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NPI Code Detail

MEDICARE: MR. TIMOTHY JOSEPH MANDA MD

MEDICARE: MR. TIMOTHY JOSEPH MANDA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician24407OK
22085R0202XDiagnostic Radiology Physician036119561IL
32085R0202XDiagnostic Radiology PhysicianME124662FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871576157
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY JOSEPH MANDA MD
Provider Business Mailing Address
First Line : 14055 RIVEREDGE DR STE 250
Second Line :
City : TAMPA
State : FL
Zip : 33637-2141
Country : US
Telephone Number : 813-929-5451
Fax Number :
Provider Business Practice Location Address
First Line : 14055 RIVEREDGE DR STE 250
Second Line :
City : TAMPA
State : FL
Zip : 33637-2141
Country : US
Telephone Number : 813-929-5451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 04/09/2025

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Directions to “ MR. TIMOTHY JOSEPH MANDA MD” Practice Location

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