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General NPI Number Information
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NPI Number | 1013061431
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Entity Type | Individual
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Provider Name | LINDA D MANDANAS MD
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 144 W 5TH ST
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City | OSWEGO
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State | NY
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Zip | 13126-2552
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Country | US
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Telephone | 315-342-1765
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Fax | 315-342-1742
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Provider Business Mailing Address
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Address Line | 144 W 5TH ST
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City | OSWEGO
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State | NY
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Zip | 13126-2552
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Country | US
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Telephone | 315-342-1765
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Fax | 315-342-1742
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 177012-1
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License Number State | NY
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