Individual
CHARLES MANDELBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
28 MAIN ST, EAST HARTFORD, CT 06118-3243
(860) 568-7212
Mailing address
28 MAIN ST, EAST HARTFORD, CT 06118-3243
(860) 568-7212
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
025804
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001258045
—
CT
Enumeration date
02/07/2006
Last updated
01/11/2008
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