Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | MD072286L | PA |
NPI | 1265493712 |
---|---|
Provider Name | Dr. Robert A. Mangano |
First Address | Danville, PA 17822-3034 |
Second Address | Danville, PA 17822-1339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 12/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001825189 | (05) | PA |
G11741 | (02) |