Mangrem, Carole L

Mangrem, Carole L is an individual health care provider with primary practice located at 2245 N Starte St , Clarksdale MS 38614. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Mangrem, Carole L can be contacted via phone (662) 627-4131.

Contact Information

Primary practice address
2245 N Starte St Clarksdale MS 38614
Phone: (662) 627-4131
Fax: (662) 627-2702
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 07191 Mississippi

Profile Details

NPI number 1497888457
LBN Legal business name Mangrem, Carole L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 13th, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497888457 NPPES
Mississippi MEDICAID 00114140

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