Provider Demographics
NPI:1528053428
Name:MANGELSDORF, HEIDI (MD)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:MANGELSDORF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 SW CARY PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5562
Mailing Address - Country:US
Mailing Address - Phone:919-467-8556
Mailing Address - Fax:919-380-1480
Practice Address - Street 1:101 SW CARY PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5562
Practice Address - Country:US
Practice Address - Phone:919-467-8556
Practice Address - Fax:919-380-1480
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC009400913207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC03-55792OtherUNITED HEALTHCARE
NC1005LOtherBLUE CROSS BLUE SHIELD
230817Medicare ID - Type Unspecified
NC03-55792OtherUNITED HEALTHCARE