Basic Information
| Provider Information | |||||||||
| NPI: | 1336305002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANGAL | ||||||||
| FirstName: | VIPUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11350 MCCORMICK RD | ||||||||
| Address2: | EXECUTIVE PLAZA 1, STE. 501 | ||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039148000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6710 OXON HILL RD STE 550 | ||||||||
| Address2: | |||||||||
| City: | OXON HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207451117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014857400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2008 | ||||||||
| LastUpdateDate: | 07/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101250847 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 0101250847 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | D80998 | MD | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.