Provider Demographics
NPI:1912339995
Name:MARANGOZ, MEHMET SERCAN (MD)
Entity Type:Individual
Prefix:
First Name:MEHMET
Middle Name:SERCAN
Last Name:MARANGOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 CONCORD AVE STE 3300
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1055
Mailing Address - Country:US
Mailing Address - Phone:617-864-8822
Mailing Address - Fax:617-354-1318
Practice Address - Street 1:725 CONCORD AVE STE 3300
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1055
Practice Address - Country:US
Practice Address - Phone:617-864-8822
Practice Address - Fax:617-354-1318
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18442207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110173746AMedicaid