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General NPI Number Information
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NPI Number | 1467434696
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Entity Type | Individual
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Provider Name | MANGALA V BETKERUR MD
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Gender | Female
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 1320 MERCY DR NW
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City | CANTON
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State | OH
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Zip | 44708-2614
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Country | US
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Telephone | 330-580-4771
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Fax | 330-458-4223
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Provider Business Mailing Address
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Address Line | 1320 MERCY DR NW
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City | CANTON
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State | OH
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Zip | 44708-2614
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Country | US
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Telephone | 330-580-4771
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Fax | 330-458-4223
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 35046019B
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License Number State | OH
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