Provider Demographics
NPI:1508850850
Name:MANGUS, LORA (MD)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:
Last Name:MANGUS
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 1:233 COLLEGE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3372
Mailing Address - Country:US
Mailing Address - Phone:717-291-7221
Mailing Address - Fax:
Practice Address - Street 1:233 COLLEGE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3372
Practice Address - Country:US
Practice Address - Phone:717-291-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434607208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200284500AMedicaid
INH17289Medicare UPIN
INH17289Medicare UPIN