Provider Demographics
NPI:1669414322
Name:MANGLA, LAL C (MD)
Entity type:Individual
Prefix:
First Name:LAL
Middle Name:C
Last Name:MANGLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 480W
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-762-1781
Mailing Address - Fax:270-762-1783
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 480W
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-762-1781
Practice Address - Fax:270-762-1783
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY19862207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64198625Medicaid
KYC69052Medicare UPIN
KYP00470814Medicare PIN
KY0982313Medicare PIN
KY1972001Medicare PIN