Basic Information
| Provider Information | |||||||||
| NPI: | 1063787240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANGLA | ||||||||
| FirstName: | ATUL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2005 TECHNOLOGY PKWY STE 400 | ||||||||
| Address2: | |||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170509413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177912520 | ||||||||
| FaxNumber: | 7177030061 | ||||||||
| Practice Location | |||||||||
| Address1: | 2005 TECHNOLOGY PKWY STE 400 | ||||||||
| Address2: | |||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170509413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177912520 | ||||||||
| FaxNumber: | 7177030061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2012 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0008X | 4301106416 | MI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neuromuscular Medicine | 2084N0400X | 4301106416 | MI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084V0102X | 4301106416 | MI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology | 2084N0400X | MD445972 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 103383230 | 05 | PA | MEDICAID |