Provider Demographics
NPI:1558320234
Name:GAKHAL, MANDIP (MD)
Entity Type:Individual
Prefix:
First Name:MANDIP
Middle Name:
Last Name:GAKHAL
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 1:4755 OGLETOWN STANTON RD
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2200
Mailing Address - Country:US
Mailing Address - Phone:302-733-1806
Mailing Address - Fax:302-733-1808
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-1806
Practice Address - Fax:302-733-1808
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00064872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000013848Medicaid
300131557OtherRAILROAD MEDICARE #
DE009681X32Medicare PIN
DE1000013848Medicaid
DE019259X70Medicare PIN