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DR. CHARLES M MANGANIELLO M.D.
>> General Practice >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1861490310
Individual Registrant:DR. CHARLES M MANGANIELLO M.D.
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
605 MAIN ST DURYEA, PA 18642-1325 US
Tel: 570-457-1110 Fax: --
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
Tel: 570-288-8881 Fax: 570-288-8065
Registration Information:
NPI: 1861490310
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 208D00000X | Allopathic & Osteopathic Physicians General Practice | PA | MD037791L |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| GEISINGER HEALTH PLAN | 14821 E222 | PA | 01 |
| 0013919460001 | PA | 05 | |
| HIGHMARK BLUE SHIELD | 024946 | PA | 01 |
| FIRST PRIORITY LIFE INS C | 024946 | PA | 01 |
| FIRST PRIORITY HEALTH | 001216 | PA | 01 |
| BLACK LUNG | 020338000 | PA | 01 |
