MEDICARE: GATEWAY RADIOLOGY CONSULTANTS PA

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	2085R0202X	Diagnostic Radiology Physician
2	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558707679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY RADIOLOGY CONSULTANTS PA

Provider Business Mailing Address
First Line	:	2100 1ST AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-1212
Country	:	US
Telephone Number	:	727-522-1061
Fax Number	:	727-528-7916

Provider Business Practice Location Address
First Line	:	2100 1ST AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-1212
Country	:	US
Telephone Number	:	727-522-1061
Fax Number	:	727-528-7916

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GAGANDEEP SINGH MANGAT
Credential	:	MD
Telephone Number	:	727-522-1061

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	03/10/2016

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Directions to “GATEWAY RADIOLOGY CONSULTANTS PA ” Practice Location

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