Provider Demographics
NPI:1508253253
Name:MENGAL, ZARA (MD)
Entity Type:Individual
Prefix:
First Name:ZARA
Middle Name:
Last Name:MENGAL
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 1:9511 SILVER COLLECTION CIR APT 214
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7828
Mailing Address - Country:US
Mailing Address - Phone:240-291-0807
Mailing Address - Fax:
Practice Address - Street 1:2200 JEFFERSON AVE
Practice Address - Street 2:GANDY OFFICE
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-7101
Practice Address - Country:US
Practice Address - Phone:419-251-1400
Practice Address - Fax:419-251-4159
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101265000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program