Basil Mangra, MD

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

ME62781 Issued in FL

Practice address

3296N State Road 7
Lauderdale Lakes, FL 33319-5615

Phone

(954) 484-6440

Fax

(954) 909-5381

NPI assigned

Sep 21, 2005

Reactivated

Apr 5, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lauderdale Lakes Medical Center, Inc.

  • Internal Medicine Physician
  • Lauderdale Lakes, FL
  • NPI 1700252079
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438041600000",
    "number": "1114913688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3296N STATE ROAD 7",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195615",
            "telephone_number": "954-484-6440",
            "fax_number": "954-909-5381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3296N STATE ROAD 7",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195615",
            "telephone_number": "954-484-6440",
            "fax_number": "954-909-5381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGRA",
        "first_name": "BASIL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2015-07-28",
        "deactivation_date": "2006-03-24",
        "reactivation_date": "2006-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "FL",
            "license": "ME62781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371342300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annie Saika Lucien
• Lynette Sieracki, DO PA
• M B Behavioral Health Services-LLC
• Mac Agency LLC
• Ricardo Francis Mandarano Jr., MSN, APRN, FNP-BC
• Manna Companion Services
• Jaime Manners
• Harry P Marcelin, PHARMD
• Shari E Marcus
• Carole Lynnette Marks, DNP, FNP-BC

• Legal Medicine in Lauderdale Lakes, FL
• Providers in Lauderdale Lakes, FL by specialty
• Legal Medicine in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.