Provider Demographics
NPI:1497070189
Name:MANGE, KEVIN C (MD MSCE)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
Last Name:MANGE
Suffix:
Gender:M
Credentials:MD MSCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 OLD SHORT HILLS RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1008
Mailing Address - Country:US
Mailing Address - Phone:973-322-4292
Mailing Address - Fax:
Practice Address - Street 1:95 OLD SHORT HILLS RD
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1008
Practice Address - Country:US
Practice Address - Phone:973-322-4292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA059872L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology