Provider Demographics
NPI:1275586729
Name:MANGAT, GAGANDEEP SINGH (MD)
Entity Type:Individual
Prefix:
First Name:GAGANDEEP
Middle Name:SINGH
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 1:4800 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3534
Mailing Address - Country:US
Mailing Address - Phone:727-522-1061
Mailing Address - Fax:727-528-7916
Practice Address - Street 1:4800 PARK BLVD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781
Practice Address - Country:US
Practice Address - Phone:727-522-1061
Practice Address - Fax:727-528-7916
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME878882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269807200Medicaid
FL43241OtherBLUE CROSS BLUE SHIELD
P00137767OtherRAILROAD MEDICARE
P00137767OtherRAILROAD MEDICARE
FL43241OtherBLUE CROSS BLUE SHIELD