Basic Information
| Provider Information | |||||||||
| NPI: | 1801074919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANGRAY | ||||||||
| FirstName: | MAHENDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600B CONGRESS ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041022124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077745222 | ||||||||
| FaxNumber: | 2077614433 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600B CONGRESS ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041022124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077745222 | ||||||||
| FaxNumber: | 2077614433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2008 | ||||||||
| LastUpdateDate: | 12/20/2017 | ||||||||
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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 | 207R00000X | 0116016860 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | MD21836 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 49419 | 01 | CO | MEDICAL LICENSE | OTHER | 7742820-1205 | 01 | UT | MEDICAL LICENSE | OTHER | 43797 | 01 | AZ | MEDICAL LICENSE | OTHER | MD21836 | 01 | ME | MEDICAL LICENSE | OTHER | 2013-01034 | 01 | NC | MEDICAL LICENSE | OTHER | MD2010-0606 | 01 | NM | MEDICAL LICENSE | OTHER |