MEDICARE: MONA M. SHANGOLD, MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	MD-043719-E	PA
2	207VG0400X	Gynecology Physician	MD-043719-E	PA

General Provider Information

NPI Number	:	1417988189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONA M. SHANGOLD, MD, PC

Provider Business Mailing Address
First Line	:	1601 WALNUT ST
Second Line	:	SUITE 1200
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2944
Country	:	US
Telephone Number	:	215-851-0999
Fax Number	:	215-851-0996

Provider Business Practice Location Address
First Line	:	1601 WALNUT ST
Second Line	:	SUITE 1200
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2944
Country	:	US
Telephone Number	:	215-851-0999
Fax Number	:	215-851-0996

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MONA MARLYNN SHANGOLD
Credential	:	M.D.
Telephone Number	:	215-851-0999

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	02/22/2008

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