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Individual

DR. KONOY MANDAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1750 E KEN PRATT BLVD, LONGMONT, CO 80504-5311
(720) 718-8310
Mailing address
1750 E KEN PRATT BLVD, LONGMONT, CO 80504-5311
(720) 718-8310

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
2002012686
MO
2084P0800X
Psychiatry Physician
Primary
DR.0050668
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1518954866
CO
05
205935307
MO
Enumeration date
10/03/2005
Last updated
09/15/2020
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