Provider Demographics
NPI:1801863931
Name:MANGEL, BARRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:D
Last Name:MANGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:770-528-9938
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-424-6893
Practice Address - Fax:770-528-9938
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2019-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA38296207RC0000X
GA038296207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000599959LMedicaid
GA000599959MMedicaid
GA000599959JMedicaid
GA000599959NMedicaid
GA000599959KMedicaid
E96436Medicare UPIN
GA202I069395Medicare PIN