Provider Demographics
NPI:1972671824
Name:MANGAT, MONA VISHIN (MD)
Entity type:Individual
Prefix:DR
First Name:MONA
Middle Name:VISHIN
Last Name:MANGAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4965 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8239
Mailing Address - Country:US
Mailing Address - Phone:727-327-5719
Mailing Address - Fax:
Practice Address - Street 1:4965 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8239
Practice Address - Country:US
Practice Address - Phone:727-327-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88726207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270694600Medicaid
FLH03993Medicare UPIN
FL48801ZMedicare PIN