Provider Demographics
NPI:1255446530
Name:VELINGKER, MANGUESH G
Entity type:Individual
Prefix:
First Name:MANGUESH
Middle Name:G
Last Name:VELINGKER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MAC
Other - Middle Name:
Other - Last Name:VELINGKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:103 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4025
Mailing Address - Country:US
Mailing Address - Phone:337-392-0222
Mailing Address - Fax:337-392-0226
Practice Address - Street 1:103 N 5TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4025
Practice Address - Country:US
Practice Address - Phone:337-392-0222
Practice Address - Fax:337-392-0226
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13834R2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1436321Medicaid
LAG20774Medicare UPIN
LA1436321Medicaid