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DR. CHARLES M MANGANIELLO M.D.

>> General Practice >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1861490310

Individual Registrant:
DR. CHARLES M MANGANIELLO M.D.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
605 MAIN ST  DURYEA, PA 18642-1325 US
Tel: 570-457-1110  Fax: --

Contact information for business:
PO BOX 1388  KINGSTON, PA 18704-0379 US
Tel: 570-288-8881  Fax: 570-288-8065

Registration Information:
NPI: 1861490310
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y208D00000XAllopathic & Osteopathic Physicians
General Practice
PAMD037791L

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
GEISINGER HEALTH PLAN14821 E222PA01
0013919460001PA05
HIGHMARK BLUE SHIELD024946PA01
FIRST PRIORITY LIFE INS C024946PA01
FIRST PRIORITY HEALTH001216PA01
BLACK LUNG020338000PA01




HEALTH CARE JOBS PA - Page 1



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