Healthcare Provider Details

I. General information

NPI: 1063875813
Provider Name (Legal Business Name): MANDAR JADHAV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 09/11/2025
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 NEW JERSEY AVE SE APT 410
WASHINGTON DC
20003-5305
US

IV. Provider business mailing address

909 NEW JERSEY AVE SE APT 410
WASHINGTON DC
20003-5305
US

V. Phone/Fax

Practice location:
  • Phone: 609-297-7464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: