DR. THEODORE DUNGAN MANDELKORN (NPI# 1922167220) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922167220 |
| Entity Type | Individual |
| Full Name | DR. THEODORE DUNGAN MANDELKORN |
| Credential | MD |
| Practice Address |
2553 76th Ave Se Mercer Island WA 98040-2758 |
| Practice Telephone | 2062750702 |
| Mailing Telephone | 2062750702 |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
MD00010762 | WA | Allopathic & Osteopathic Physicians |
| Street Address |
2553 76TH AVE SE |
| City | MERCER ISLAND |
| State | WA |
| Zip Code | 98040-2758 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316925357 | Julie Ellner | Pediatrics | 2553 76th Ave Se, Mercer Island, WA 98040-2758 | 2006-01-09 |
| 1336349422 | Mercer Island Pediatric Associates | Pediatrics | 2553 76th Ave Se, Mercer Island, WA 98040-2758 | 2007-07-18 |
| 1588772511 | Danette Swanson Glassy | Pediatrics | 2553 76th Ave Se, Mercer Island, WA 98040-2758 | 2006-08-29 |
| 1144285388 | Hal Cooper Quinn | Pediatrics | 2553 76th Ave Se, Mercer Island, WA 98040-2758 | 2006-04-19 |
| 1902877103 | John Gerard Schreuder | Pediatrics | 2553 76th Ave Se, Mercer Island, WA 98040-2758 | 2006-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902440266 | Michael Cottrell Johnson | Technician | 3812 W. Mercer Way, Mercer Island, WA 98040 | 2019-10-30 |
| 1881237048 | Lisa Catherine Stewart | Social Worker | Mental Health & Addiction Services, 401 Broadway, Seattle, WA 98040 | 2019-10-21 |
| 1023520665 | Aca Wa Group Corp | Massage Therapist | 7605 Se 27th St, Suite 103, Mercer Island, WA 98040 | 2017-11-03 |
| 1699211995 | Wei Fan | Acupuncturist | 7605 Se 27th Street, Suite 103, Mercer Island, WA 98040 | 2017-01-10 |
| 1346691953 | James M Blue | Neurological Surgery | 4882 Forest Ave S.e., Mercer Island, WA 98040 | 2016-06-24 |
| 1982058418 | Ray Johnson | Physician Assistant | 4446 88th Ave Se, Mercer Island, WA 98040 | 2016-04-21 |
| 1780072900 | The Emily Program PC | Psychiatric Residential Treatment Facility | 7275 N. Mercer Way, Mercer Island, WA 98040 | 2014-12-23 |
| 1609115641 | Richard Daifuku | Specialist | 9270 Se 36th Pl, Mercer Island, WA 98040 | 2013-02-12 |
| 1689937286 | Karin L. Miller | Social Worker | 9725 Se. 36 St. #301, Mercer Island, WA 98040 | 2012-06-19 |
| 1689947608 | Hector Cantu Aldape | Pathology | 7649 West Mercer Way, Mercer Island, WA 98040 | 2012-02-22 |
| Find all providers in zip 98040 | ||||
| Taxonomy Code | 2080P0006X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Developmental – Behavioral Pediatrics |
| A developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed, 3/26/2008: definition corrected] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275533838 | Lilliam A Sierra | Pediatrics | 7301 W Deschutes Ave, Suite A, Kennewick, WA 99336-7757 | 2005-07-26 |
| 1215460860 | Kira Belzer | Pediatrics | Madigan Army Medical Center 9040 Jackson Ave, Tacoma, WA 98431-0001 | 2017-04-10 |
| 1568880276 | Angela J Armen | Pediatrics | 4800 Sand Point Way Ne, Seattle, WA 98105-3901 | 2014-03-31 |
| 1700103462 | Providence Physician Services Co | Pediatrics | 101 W 8th Ave, Ste 4200, Spokane, WA 99204-2307 | 2010-04-21 |
| 1790910701 | Lisa Diane Herzig | Pediatrics | 4800 Sand Point Way Ne, M/s Oc.9.840, Seattle, WA 98105-3901 | 2009-05-19 |
| 1710135926 | Emily Myers | Pediatrics | 4800 Sand Point Way Ne, Oc.9.840, Seattle, WA 98105-3901 | 2008-08-29 |
| 1093931339 | Sterling K Clarren | Pediatrics | 2142 10th Ave W, Seattle Children's Home, Seattle, WA 98119-2845 | 2007-04-17 |
| 1073646469 | Natasha Hays | Pediatrics | 677 Woodland Square Loop Se, Lacey, WA 98503-1000 | 2007-03-14 |
| 1205972791 | Deanna Sue Livingstone | Pediatrics | 9040 Reid Street, A, Tacoma, WA 98431-1100 | 2007-01-30 |
| 1912065889 | David Laverne Burkebile | Pediatrics | 601 S Carr Rd, Suite 420, Renton, WA 98055-5866 | 2006-12-04 |
| Find all providers with the same taxonomy | ||||
| City | MERCER ISLAND |
| Zip Code | 98040 |
Please comment or provide details below to improve the information on DR. THEODORE DUNGAN MANDELKORN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.