Individual
KIRAN A MANGALAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
149 NORTH ST, WATERVILLE, ME 04901-4974
(207) 861-5101
(207) 872-4341
Mailing address
149 NORTH ST, WATERVILLE, ME 04901-4974
(207) 861-5101
(207) 872-4341
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
2144
ME
207Q00000X
Family Medicine Physician
2144
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432682599
—
ME
01
—
MM7302
MEDICARE ID - GROUP
—
Enumeration date
08/25/2006
Last updated
05/31/2019
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