Provider Demographics
NPI:1265450100
Name:MANGAT, DEVINDER S (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVINDER
Middle Name:S
Last Name:MANGAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BARNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2500
Mailing Address - Country:US
Mailing Address - Phone:859-331-9600
Mailing Address - Fax:859-331-5831
Practice Address - Street 1:133 BARNWOOD DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2500
Practice Address - Country:US
Practice Address - Phone:859-331-9600
Practice Address - Fax:859-331-5831
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY176262082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC72099Medicare UPIN
OHMA0510722Medicare ID - Type UnspecifiedOHIO MEDICARE NUMBER
KY1246201Medicare ID - Type UnspecifiedKENTUCKY MEDICARE NUMBER