Provider Demographics
NPI:1922009794
Name:PAWAR, MANGALA H (MD)
Entity Type:Individual
Prefix:
First Name:MANGALA
Middle Name:H
Last Name:PAWAR
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 1:14133 ROBERT PARIS CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-4203
Mailing Address - Country:US
Mailing Address - Phone:703-956-6757
Mailing Address - Fax:855-359-2261
Practice Address - Street 1:14113 ROBERT PARIS CT
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-4200
Practice Address - Country:US
Practice Address - Phone:703-956-6757
Practice Address - Fax:855-359-2261
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056232207P00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101227651OtherSTATE LICENSE