Provider Demographics
NPI:1902889207
Name:KUNEN, MANDI ZALTAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MANDI
Middle Name:ZALTAS
Last Name:KUNEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1013
Mailing Address - Country:US
Mailing Address - Phone:508-358-1644
Mailing Address - Fax:
Practice Address - Street 1:131 ORNAC
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4185
Practice Address - Country:US
Practice Address - Phone:978-369-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77952207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology