Healthcare Provider Details

I. General information

NPI: 1891804639
Provider Name (Legal Business Name): KATHERINE A MANDELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY STE 300
SEATTLE WA
98122-4334
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-3500
  • Fax: 206-215-6499
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-233-7489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number249570
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number249570
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number249570
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: