Basic Information
| Provider Information | |||||||||
| NPI: | 1649272949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANGLA | ||||||||
| FirstName: | BHUPESH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 226 MILL HILL AVE. | ||||||||
| Address2: | 3RD FL. | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032722248 | ||||||||
| FaxNumber: | 2032729690 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 CHAPEL ST | ||||||||
| Address2: | DEPARTMENT OF MEDICINE, HOSPITAL OF SAINT RAPHAEL | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065114405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037893203 | ||||||||
| FaxNumber: | 2037893222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 09/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0901X | 040017 | CT | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | 207R00000X | 040017 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001400176 | 05 | CT | MEDICAID |