Provider Demographics
NPI:1285616821
Name:MANGIALARDI, WENDY J (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:MANGIALARDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1900 PATTERSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2119
Mailing Address - Country:US
Mailing Address - Phone:615-321-9556
Mailing Address - Fax:615-321-9544
Practice Address - Street 1:1900 PATTERSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2119
Practice Address - Country:US
Practice Address - Phone:615-321-9556
Practice Address - Fax:615-321-9544
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028484207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3846397Medicaid
TN3846397Medicaid
TNH05981Medicare UPIN