Provider Demographics
NPI:1992848386
Name:KHADILKAR, MANGALA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANGALA
Middle Name:
Last Name:KHADILKAR
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 1:345 CONCORD CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4409
Mailing Address - Country:US
Mailing Address - Phone:215-357-5383
Mailing Address - Fax:
Practice Address - Street 1:1001 STERIGERE ST
Practice Address - Street 2:NORRISTOWN STATE HOSPITAL
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-5300
Practice Address - Country:US
Practice Address - Phone:610-313-5647
Practice Address - Fax:610-313-1013
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-038005-L2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG14834Medicare UPIN
PA804556KKBMedicare PIN