Provider Demographics
NPI:1922303361
Name:MONGARE, JAPHETH OGAMBA (DPM)
Entity Type:Individual
Prefix:
First Name:JAPHETH
Middle Name:OGAMBA
Last Name:MONGARE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 TOWN PL
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1761
Mailing Address - Country:US
Mailing Address - Phone:203-606-2694
Mailing Address - Fax:
Practice Address - Street 1:6212 TOWN PL
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1761
Practice Address - Country:US
Practice Address - Phone:203-606-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-16
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH59.000264213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery