Provider Demographics
NPI:1366499246
Name:VANGALA, RAHUL KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:KUMAR
Last Name:VANGALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAHUL
Other - Middle Name:K
Other - Last Name:VANGALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3964 ELNORA DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1825
Mailing Address - Country:US
Mailing Address - Phone:478-477-1777
Mailing Address - Fax:478-477-1779
Practice Address - Street 1:3964 ELNORA DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1825
Practice Address - Country:US
Practice Address - Phone:478-477-1777
Practice Address - Fax:478-477-1779
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39257207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology