Provider Demographics
NPI:1821146192
Name:MANGLA, RAKHEE (MD)
Entity Type:Individual
Prefix:
First Name:RAKHEE
Middle Name:
Last Name:MANGLA
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 1:80 SCENIC CT
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2330
Mailing Address - Country:US
Mailing Address - Phone:203-376-9050
Mailing Address - Fax:203-789-3222
Practice Address - Street 1:24 STEVENS ST
Practice Address - Street 2:SUITE I
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3852
Practice Address - Country:US
Practice Address - Phone:203-582-3455
Practice Address - Fax:203-855-3583
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043711207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI40745Medicare UPIN