Individual
DR. KENNETH D MANDL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
300 LONGWOOD AVE, CHILDREN'S HOSPITAL BOSTON, BOSTON, MA 02115-5735
(617) 355-6624
(617) 730-0335
Mailing address
300 LONGWOOD AVE, CHILDREN'S HOSPITAL BOSTON-DIVISION OF EMERGENCY MED, BOSTON, MA 02115-5737
(617) 355-6624
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
75410
MA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
75410
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3107180
—
MA
Enumeration date
08/24/2006
Last updated
08/16/2007
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