Individual
DR. BELA S MANDAVILLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
111 FOUNDERS PLZ, #300 C/O IPMS, EAST HARTFORD, CT 06108-3212
(860) 282-4137
(860) 282-0170
Mailing address
41 BREWSTER RD, BRISTOL, CT 06010-5161
(860) 585-3591
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
037000
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001370006
—
CT
Enumeration date
11/04/2005
Last updated
01/24/2020
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