Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 36054-1 | NY |
NPI | 1164492526 |
---|---|
Provider Name | Dr. Albert M Manganaro |
First Address | Fort Bragg, NC 28310-7302 |
Second Address | Fort Bragg, NC 28310-7302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 09/09/2008 |