Provider Demographics
NPI:1609040401
Name:MANGALAT, DEV (MD)
Entity Type:Individual
Prefix:DR
First Name:DEV
Middle Name:
Last Name:MANGALAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-531-2435
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:678-207-4000
Practice Address - Fax:770-531-2435
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1455712086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA794441598AMedicaid
GA794441598BMedicaid
GA794441598DMedicaid
GAP00903608OtherMEDICARE RAILROAD
GA4453689OtherCIGNA
GA01355160OtherAMERIGROUP
GA9102580OtherAETNA
GA3186961OtherUHC
GA52289700OtherBCBS
GA559684OtherWELLCARE
GA202I775361Medicare PIN