Healthcare Provider Details

I. General information

NPI: 1992925846
Provider Name (Legal Business Name): ANITA MANDAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 PGA BLVD SUITE 146
PALM BEACH GARDENS FL
33410-3590
US

IV. Provider business mailing address

2401 PGA BLVD SUITE 146
PALM BEACH GARDENS FL
33410-3590
US

V. Phone/Fax

Practice location:
  • Phone: 561-238-0040
  • Fax: 561-238-0041
Mailing address:
  • Phone: 561-238-0040
  • Fax: 561-238-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberME9198
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberME9198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: