Provider Demographics
NPI:1851627756
Name:MANGELSON, NED LEGRANDE (MD)
Entity Type:Individual
Prefix:DR
First Name:NED
Middle Name:LEGRANDE
Last Name:MANGELSON
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 1:2691 ROXBURY CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2841
Mailing Address - Country:US
Mailing Address - Phone:801-582-4567
Mailing Address - Fax:
Practice Address - Street 1:2691 ROXBURY CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2841
Practice Address - Country:US
Practice Address - Phone:801-582-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1465731205208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology