Provider Demographics
NPI:1437103595
Name:KATIKINENI, MANGAL (MD)
Entity Type:Individual
Prefix:
First Name:MANGAL
Middle Name:
Last Name:KATIKINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANGAL
Other - Middle Name:
Other - Last Name:KATIKINENI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6504 KENILWORTH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1386
Mailing Address - Country:US
Mailing Address - Phone:301-927-0088
Mailing Address - Fax:301-927-7239
Practice Address - Street 1:6502 KENILWORTH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1340
Practice Address - Country:US
Practice Address - Phone:301-927-0088
Practice Address - Fax:301-927-7239
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026230207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD079201200Medicaid
MD092649R96Medicare ID - Type Unspecified
MDD09326Medicare UPIN