Healthcare Provider Details

I. General information

NPI: 1184741415
Provider Name (Legal Business Name): NEDKA MANDOFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LOWER MARY HILL ROAD COMMONWEALTH HEALTH CENTER
SAIPAN MP
96950
US

IV. Provider business mailing address

PO BOX 500409
SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-8950
  • Fax: 670-236-8600
Mailing address:
  • Phone: 670-234-8950
  • Fax: 670-236-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0378
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: