1467453035 NPI number — DR. MARINA MANGAOANG GARCIA M.D.

Table of content: DR. MARINA MANGAOANG GARCIA M.D. (NPI 1467453035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467453035 NPI number — DR. MARINA MANGAOANG GARCIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA
Provider First Name:
MARINA
Provider Middle Name:
MANGAOANG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467453035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 NATTULL DR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAR
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19701-4909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-838-0904
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 RYAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RISING SUN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21911-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-658-1300
Provider Business Practice Location Address Fax Number:
410-658-1828
Provider Enumeration Date:
08/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  D0057369 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: C10005760 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000032926 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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