Provider Demographics
NPI:1881672830
Name:MANGASER, RHODORA D (MD)
Entity Type:Individual
Prefix:
First Name:RHODORA
Middle Name:D
Last Name:MANGASER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 SOMERDALE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1858
Mailing Address - Country:US
Mailing Address - Phone:856-857-0002
Mailing Address - Fax:856-857-0040
Practice Address - Street 1:600 SOMERDALE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1858
Practice Address - Country:US
Practice Address - Phone:856-857-0002
Practice Address - Fax:856-857-0040
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04576300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2218607Medicaid
C59832Medicare UPIN