Provider Demographics
NPI:1295031920
Name:RAJU MANGROLA, MD, PA
Entity Type:Organization
Organization Name:RAJU MANGROLA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGROLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-691-1400
Mailing Address - Street 1:4600 MILITARY TRAIL
Mailing Address - Street 2:SUITE 206
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4812
Mailing Address - Country:US
Mailing Address - Phone:561-691-1400
Mailing Address - Fax:561-691-1423
Practice Address - Street 1:4600 MILITARY TRAIL
Practice Address - Street 2:SUITE 206
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4812
Practice Address - Country:US
Practice Address - Phone:561-691-1400
Practice Address - Fax:561-691-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09932Medicare PIN