Mandrola, Staci A

Mandrola, Staci A is an individual health care provider with primary practice located at 7504 Westport Rd , Louisville KY 40222-4108. She recently has only one registered license in Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine, which is considered as her primary health care specialty. Mandrola, Staci A can be contacted via phone (502) 693-2681.

Contact Information

Primary practice address
7504 Westport Rd Louisville KY 40222-4108
Phone: (502) 693-2681
Fax: (502) 456-9738
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine 207RH0002X 41139 Kentucky

Profile Details

NPI number 1912129552
LBN Legal business name Mandrola, Staci A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2007
Last updated Jan 11th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912129552 NPPES
Kentucky Other 000000642419 ANTHEM
Kentucky Other 3756448000 ANTHEM
Kentucky MEDICAID 7100094260 ANTHEM
Kentucky Other 50026942 ANTHEM

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