Provider Demographics
NPI:1649272949
Name:MANGLA, BHUPESH (MD)
Entity type:Individual
Prefix:
First Name:BHUPESH
Middle Name:
Last Name:MANGLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:226 MILL HILL AVE.
Mailing Address - Street 2:3RD FL.
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610
Mailing Address - Country:US
Mailing Address - Phone:203-272-2248
Mailing Address - Fax:203-272-9690
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE, HOSPITAL OF SAINT RAPHAEL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3203
Practice Address - Fax:203-789-3222
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0400172083P0901X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001400176Medicaid
CTH94559Medicare UPIN
CT001400176Medicaid