MEDICARE: DR. RAMNISH JAGDISH MANDRELLE MBBS, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD60063868	WA
2	207Q00000X	Family Medicine Physician	MD179005	OR
3	207Q00000X	Family Medicine Physician	DR.0067392	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0252141	OTHER	WA	STATE L&I

General Provider Information

NPI Number	:	1982865739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMNISH JAGDISH MANDRELLE MBBS, MD

Provider Business Mailing Address
First Line	:	500 NE MULTNOMAH ST STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2031
Country	:	US
Telephone Number	:	800-813-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 7TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-3198
Country	:	US
Telephone Number	:	800-813-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	05/11/2026

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