Basic Information
| Provider Information | |||||||||
| NPI: | 1255865309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATIL | ||||||||
| FirstName: | MANGALADEVI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 HARVESTVIEW DR | ||||||||
| Address2: | |||||||||
| City: | MONROE TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088312367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014418995 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1364 CLIFTON RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047275658 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2017 | ||||||||
| LastUpdateDate: | 04/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.