Provider Demographics
NPI:1780636126
Name:MANGRU, NEVINDRA N (MD)
Entity Type:Individual
Prefix:DR
First Name:NEVINDRA
Middle Name:N
Last Name:MANGRU
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 1:155 HOSPITAL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2494
Mailing Address - Country:US
Mailing Address - Phone:931-962-0672
Mailing Address - Fax:931-967-7818
Practice Address - Street 1:155 HOSPITAL RD
Practice Address - Street 2:SUITE E
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2494
Practice Address - Country:US
Practice Address - Phone:931-962-0672
Practice Address - Fax:931-967-7818
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD27640208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3099893Medicaid
TN3118089OtherBCBS
TN3118089OtherBCBS