Individual
DR. MANDAR R JAGTAP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1310 HIGHWAY 72 E, CORINTH, MS 38834-6524
(662) 594-4123
(625) 942-2966
Mailing address
PO BOX 1470, CORINTH, MS 38835-1470
(662) 287-5218
(662) 286-3186
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
25097
MS
207RC0000X
Cardiovascular Disease Physician
OS13840
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03005201
—
MS
01
—
1H1365
MS MEDICARE INDIVIDUAL
MS
Enumeration date
07/02/2009
Last updated
07/07/2021
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