Healthcare Provider Details

I. General information

NPI: 1467453035
Provider Name (Legal Business Name): MARINA MANGAOANG GARCIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 RYAN DR
RISING SUN MD
21911-1840
US

IV. Provider business mailing address

409 NATTULL DR RD
BEAR DE
19701-4909
US

V. Phone/Fax

Practice location:
  • Phone: 410-658-1300
  • Fax: 410-658-1828
Mailing address:
  • Phone: 302-838-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0057369
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10005760
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: