Basic Information
| Provider Information | |||||||||
| NPI: | 1750641668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANGEWALA | ||||||||
| FirstName: | VIKAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 ARLINGTON AVE | ||||||||
| Address2: | GRADUATE MEDICAL EDUCATION MS 1193 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193835695 | ||||||||
| FaxNumber: | 4193833031 | ||||||||
| Practice Location | |||||||||
| Address1: | 3930 PENDER DR STE 350 | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220300989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038658686 | ||||||||
| FaxNumber: | 7038656506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2012 | ||||||||
| LastUpdateDate: | 02/13/2019 | ||||||||
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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 | 2084P0804X | 0101262439 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.