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General NPI Number Information
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NPI Number | 1689914780
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Entity Type | Organization
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Legal Business Name | RHODORA MANGASER MD LLC
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Dates
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Enumeration Date | 02/26/2013
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 600 SOMERDALE RD SUITE 101
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City | VOORHEES
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State | NJ
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Zip | 08043-1858
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Country | US
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Telephone | 856-857-0002
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Fax | 856-857-0040
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Provider Business Mailing Address
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Address Line | 600 SOMERDALE RD SUITE 101
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City | VOORHEES
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State | NJ
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Zip | 08043-1858
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Country | US
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Telephone | 856-857-0002
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Fax | 856-857-0040
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | DR. RHODORA D MANGASER
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Credential | MD
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Telephone | 856-857-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 25MA04576300
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License Number State | NJ
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