Provider Demographics
NPI:1467430223
Name:MANGLA, PAWAN (MD)
Entity Type:Individual
Prefix:
First Name:PAWAN
Middle Name:
Last Name:MANGLA
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 1:31594 SCHWARTZ RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-3754
Mailing Address - Country:US
Mailing Address - Phone:440-835-2779
Mailing Address - Fax:440-835-2779
Practice Address - Street 1:25967 WOODPATH TRL
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5713
Practice Address - Country:US
Practice Address - Phone:440-835-2779
Practice Address - Fax:440-835-2779
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0646215Medicaid
OH0646215Medicaid
OHA82604Medicare UPIN
OHP00936308Medicare PIN
OH0591266Medicare PIN