Individual
NAGESWARA R MANDAVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14601 45TH AVE, SUITE 405, FLUSHING, NY 11355-2200
(718) 670-5202
(718) 670-5312
Mailing address
PO BOX 740008, REGO PARK, NY 11374-0008
(718) 670-5202
(718) 670-5312
Taxonomy
Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
165321
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01124258
—
NY
Enumeration date
08/09/2005
Last updated
06/17/2010
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