Provider Demographics
NPI:1750556973
Name:MANGRUM, RHONDA SPRING (MD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:SPRING
Last Name:MANGRUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:SPRING
Other - Last Name:HOUPT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4012 RAINTREE RD
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-3741
Mailing Address - Country:US
Mailing Address - Phone:757-488-2223
Mailing Address - Fax:757-488-8398
Practice Address - Street 1:4012 RAINTREE RD
Practice Address - Street 2:SUITE 200A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-3741
Practice Address - Country:US
Practice Address - Phone:757-488-2223
Practice Address - Fax:757-488-8398
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243455208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics