1699873992 NPI number — MR. WILLIAM SCOTT MANDEL M.D.

Table of content: MR. WILLIAM SCOTT MANDEL M.D. (NPI 1699873992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699873992 NPI number — MR. WILLIAM SCOTT MANDEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANDEL
Provider First Name:
WILLIAM
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANDEL
Provider Other First Name:
SCOTT
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699873992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPTAIN COOK
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96704-0202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-323-8200
Provider Business Mailing Address Fax Number:
808-323-8400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82-6123 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
TOP FLOOR
Provider Business Practice Location Address City Name:
CAPTAIN COOK
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96704-8203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-323-8200
Provider Business Practice Location Address Fax Number:
808-323-8400
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  3644 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01159301 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: C1212-4 . This is a "HMSA PROVIDER NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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