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Individual

DR. MAHENDRA MANGRAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1600B CONGRESS ST, PORTLAND, ME 04102-2124
(207) 774-5222
(207) 761-4433
Mailing address
1600B CONGRESS ST, PORTLAND, ME 04102-2124
(207) 774-5222
(207) 761-4433

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0116016860
VA
207RN0300X
Nephrology Physician
Primary
MD21836
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2013-01034
MEDICAL LICENSE
NC
01
43797
MEDICAL LICENSE
AZ
01
49419
MEDICAL LICENSE
CO
01
7742820-1205
MEDICAL LICENSE
UT
01
MD2010-0606
MEDICAL LICENSE
NM
01
MD21836
MEDICAL LICENSE
ME
Enumeration date
01/31/2008
Last updated
12/20/2017
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