Provider Demographics
NPI:1285729137
Name:MANGILOG, MARIBEL ORANTE (MD)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:ORANTE
Last Name:MANGILOG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIBEL
Other - Middle Name:BASINAL
Other - Last Name:ORANTE-MANGILOG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4881 SUGAR MAPLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WRIGHT-PATTERSON AFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433
Mailing Address - Country:US
Mailing Address - Phone:937-257-9392
Mailing Address - Fax:937-256-1175
Practice Address - Street 1:4881 SUGAR MAPLE DRIVE
Practice Address - Street 2:
Practice Address - City:WRIGHT-PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433
Practice Address - Country:US
Practice Address - Phone:937-257-9392
Practice Address - Fax:937-256-1175
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18429207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine