Individual
DR. VENKATACHALAM MANGESHKUMAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
640 EAST OREGON ROAD, LITITZ, PA 17543
(717) 569-8773
(717) 569-8187
Mailing address
640 E OREGON RD, LITITZ, PA 17543-9202
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD061259L
PA
207R00000X
Internal Medicine Physician
MD0611259L
PA
2084N0400X
Neurology Physician
Primary
MD0611259L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001672400 0003
—
PA
05
—
0016724000003
—
PA
Enumeration date
09/08/2005
Last updated
11/06/2023
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