Provider Demographics
NPI:1467453035
Name:GARCIA, MARINA MANGAOANG (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:MANGAOANG
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 NATTULL DR RD
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4909
Mailing Address - Country:US
Mailing Address - Phone:302-838-0904
Mailing Address - Fax:
Practice Address - Street 1:120 RYAN DR
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-1840
Practice Address - Country:US
Practice Address - Phone:410-658-1300
Practice Address - Fax:410-658-1828
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057369208000000X
DEC10005760208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000032926Medicaid