Provider Demographics
NPI:1992503056
Name:GILGEOUS, MAHOGANY V (NP)
Entity type:Individual
Prefix:
First Name:MAHOGANY
Middle Name:V
Last Name:GILGEOUS
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HOSCOTT DR
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1827
Mailing Address - Country:US
Mailing Address - Phone:860-514-3780
Mailing Address - Fax:
Practice Address - Street 1:12 HOSCOTT DR
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1827
Practice Address - Country:US
Practice Address - Phone:860-514-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14549363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner