Healthcare Provider Details

I. General information

NPI: 1073515763
Provider Name (Legal Business Name): OFELIA RAMOSO MANGUBAT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD THE PAVILIONS OF VOORHEES, STE 405
VOORHEES NJ
08043-4501
US

IV. Provider business mailing address

2301 E EVESHAM RD THE PAVILIONS OF VOORHEES, STE 405
VOORHEES NJ
08043-4501
US

V. Phone/Fax

Practice location:
  • Phone: 856-772-4988
  • Fax: 856-772-2514
Mailing address:
  • Phone: 856-772-4988
  • Fax: 856-772-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA34367
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: