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NPI Code Detail

MEDICARE: DR. VIKAS MANGEWALA M.D.

MEDICARE: DR. VIKAS MANGEWALA M.D.
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
12084P0804XChild & Adolescent Psychiatry Physician0101262439VA

General Provider Information

NPI Number : 1750641668
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VIKAS MANGEWALA M.D.
Provider Business Mailing Address
First Line : 3000 ARLINGTON AVE
Second Line : GRADUATE MEDICAL EDUCATION MS 1193
City : TOLEDO
State : OH
Zip : 43614-2595
Country : US
Telephone Number : 419-383-5695
Fax Number : 419-383-3031
Provider Business Practice Location Address
First Line : 3930 PENDER DR STE 350
Second Line :
City : FAIRFAX
State : VA
Zip : 22030-0989
Country : US
Telephone Number : 703-865-8686
Fax Number : 703-865-6506
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2012
Last Update Date : 02/13/2019

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Directions to “ DR. VIKAS MANGEWALA M.D.” Practice Location

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