Provider Demographics
NPI:1871540484
Name:MANGULABNAN, MELVIN SERRANO (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:SERRANO
Last Name:MANGULABNAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3455
Mailing Address - Country:US
Mailing Address - Phone:716-667-3492
Mailing Address - Fax:
Practice Address - Street 1:3918 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3411
Practice Address - Country:US
Practice Address - Phone:716-675-4433
Practice Address - Fax:716-675-5212
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2010-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY189425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF63820Medicare UPIN